Histopathological Evaluation of Skin Neoplasms

We retrospectively reviewed the clinical features and outcome of benign and malignant eyelid tumors from 1995 to 2015 in a tertiary medical center. Among 4,521 histologically confirmed eyelid tumors, 4,294 (95.0%) were benign tumors and 227 (5.0%) were malignant tumors. The mean age at diagnosis was significantly higher in patients with malignant lid tumors than those with benign lid tumors (72.5 and 55.4 years, resp., p < 0.001). The most common benign eyelid tumors were intradermal nevus (21.1%), followed by seborrheic keratosis (12.6%) and xanthelasma (11.2%). The most common malignant eyelid tumors were basal cell carcinomas (57.8%), followed by sebaceous gland carcinomas (21.1%) and squamous cell carcinomas (10.1%). There was a relative male predominance (63.4% and 49.2%, resp., p < 0.001) and higher recurrence rate (11.9% and 4.4%, resp., p < 0.001) in malignant lid tumors as compared with those of benign lid tumors. Twenty-two patients (9.7%) received orbital exenteration/enucleation. Eight patients (3.5%) with malignant lid tumors died of disease. Patients with eyelid melanoma were associated with a high mortality rate (25.0%). It is important to differentiate between benign and malignant eyelid tumors, because they may cause cosmetic disfigurement and severe morbidity, especially in those with malignant eyelid tumors.

Background and AimsSkin tumors are one of the most common complaints among patients due to their external location and esthetic reasons. Skin tumors have a wide spectrum from being benign, with only esthetic problems, to malignant, which can be fatal. This study aimed to describe the epidemiologic profile of skin tumors in the Philippine General Hospital Out‐patient Services.MethodsThis is a cross‐sectional study that describes the epidemiologic profile of the different skin tumors among Filipinos who consulted at the Philippine General Hospital Out‐patient Services.ResultsBenign skin tumors are more common than malignant ones. Benign skin tumors are commonly seen in middle‐aged adults, with a median age of 33 years. There was a higher proportion of benign tumors among females (n = 1256/1529, 82.15%) compared to males (n = 690/923, 74.76%). The site of predilection was the head and neck region. The most common benign skin tumor was the intradermal nevus. The older adult age group had a higher predilection for malignant tumors, with a median age of 57 years. Relatively, there was higher proportion of malignant tumors among males (n = 223/923, 25.24%) compared to females (n = 273/1529, 17.85%). The site of predilection is also the head and neck region. Among malignant skin tumors, basal cell carcinoma is the most common skin cancer.ConclusionThe epidemiologic profile of skin tumors from patients seen in the Philippine General Hospital in terms of median age at diagnosis, sex preponderance, site of predilection, and tumor classification was similar to various Asian countries located in relatively the same latitude as the Philippines.

To investigate the incidence and constituent characteristic of neoplasm in oromaxillo-facial region in Xinjiang. A total of 2161 patients with benign or malignant oral-maxillofacial tumors diagnosed in Department of Dentofacial Surgery of the First Affiliated Hospital of Xinjiang Medical College from 1995 to 2009 were analyzed retrospectively. Of the 2161 cases, 58.49% (1264/2161) was benign tumors, 33.13% (716/2161) malignant tumors, and 8.38% (181/2161) tumor-like lesions. The most common benign tumors were pleomorphic adenoma, hemangioma, papilloma, adenolymphoma and ameloblastoma. Squamous cell carcinoma constituted the majority of the malignant tumors. The most common malignant tumors of salivary gland were adenoid cystic carcinoma. The most common odontogenic tumors was ameloblastoma. The most common sites of malignant tumors were tongue, lip, parotiod gland and buccal mucosa. The common pathological type of oral and maxillofacial benign neoplasm and the most common sites of malignancy in Xinjiang region were similar to those of other places inside and outside the country. Adenoid cystic carcinoma was more common than other salivary originated tumors. There was more malignant tumors in Uygur nationality than in Han living in the same region.

Purpose: To present the profile of patients with ocular and adnexal tumours presenting at a tertiary eye care institute in northeast India in ten years between 2003 and 2013.Design: Hospital based retrospective review of medical records.Method: The clinical history, site of involvement and pathological diagnoses were retrieved from ocular pathology registers from October 2003-October 2013. This included conjunctival, orbital, adnexal and intraocular tumours. All specimens were fixed, processed and stained. Immunohistochemistry was carried out where ever indicated to come to a final diagnosis.Results: In all 1003 cases were included in our study, with 622 (62.01%) benign tumours and 381 (37.98%) malignant tumours. 54.63% were males and 45.36% were females. Amongst the conjunctival tumours, squamous cell carcinoma (SCC) (72.5%) and nevus (39.6%) were the most common malignant and benign tumour, respectively. Non-Hodgkin’s lymphoma (NHL) (60%) was the most common malignant orbital tumour. Retinoblastoma (RB) (81.5%) was the most common intraocular malignancy, followed by melanoma (18.4%). Basal cell carcinoma (BCC) (35.1%) was the most common malignancy in the lid.Conclusion: NHL and SCC were the most frequently seen malignant tumours in adults while RB was the most common intraocular tumour in children.

Introduction: Middle ear tumours are rare neoplasms that have nonspecific clinical presentation, otoscopic and imaging features and pose a diagnostic challenge. Most common neoplasm of middle ear are paraganglioma, schwannoma, haemangioma and middle ear adenoma. Aim: To analyse the relative incidence, clinical presentation and histopathological spectrum of neoplasms in the middle ear at a tertiary care hospital, Hyderabad, Telangana, India. Materials and Methods: This retrospective study was conducted in Department of Pathology at Government ENT Hospital (tertiary referral ENT Hospital), Hyderabad, Telangana, India, from July 2014 to June 2019. Total 26 cases of middle ear tumours both incisional or excisional biopsies of middle ear lesions from all age group both males and females with complete clinical details were included in the study. Clinical and histopathological data were analysed after processing the sections with Hematoxylin and Eosin (H&amp;E) stains examined microscopically. Statistical analysis was done using Statistical Package for Social Science (SPSS) version 20.0 and mean, standard deviation and percentages were calculated. Results: In the present study, maximum patients 11 (42.3%) were in age group of 41 to 50 years with female preponderance 18 (69%). Mean age of the patients was 42.92±12.53 years. Out of a total of 26 cases, 20 cases were benign neoplasms and six cases were malignant. Most common side of presentation was right side. Most of the benign tumours occurred in the 5th decade and malignant tumours were common in the 6th decade. Paragangliomas/Glomustympanicum tumours were most common benign tumours followed by schwannoma, haemangioma and middle ear adenoma. Whereas among malignant tumour , squamous cell carcinoma was common. Conclusion: Middle ear tumours are relatively uncommon lesions presenting as mass in the ear, discharge, hearing loss, tinnitus and chronic suppurative otitis media. Benign tumours are more common than malignant tumours in the middle ear. Paraganglioma was the most common benign tumour encountered, followed by schwannomas, middle ear adenomas and haemangiomas. Middle ear tumours are rare and histologic analysis is essential for definitive diagnosis and treatment.

Surgical Treatment of Benign Cardiac Tumors

We evaluated ultrasonographic features of superficial epidermoid tumour with a focus on strain elastography (SE) features that will help in the differential diagnosis of epidermoid tumour from other benign and malignant soft-tissue tumours. We retrospectively evaluated ultrasonographic and SE data of 103 surgically confirmed superficial soft-tissue tumours and tumour-like lesions: 29 cases of epidermoid tumour, 46 cases of other benign tumours and 28 cases of malignant tumour. SE and B-mode imaging were performed at the same time. SE characteristics were assigned into four grades (1-4) according to their elasticity. Interobserver agreement for the four SE scores between the two radiologists was analysed using kappa statistics. We classified each SE finding as a hard lesion (SE Score 3-4) or soft lesion (SE Score 1-2) and compared these findings using the χ(2) test to identify whether a significant difference in mass hardness existed among epidermoid tumour, other benign tumour and malignant tumour. Overall interobserver agreement according to the four SE scores was moderate (κ = 0.540), and overall agreement for the hardness [soft (Score 1-2) or hard (Score 3-4)] was almost perfect (κ = 0.825). Malignant tumours showed higher SE scores (3-4, hard nature) than did epidermoid tumour or other benign soft-tissue tumours. There were no differences in SE score between epidermoid tumour and other benign tumours. Superficial epidermoid tumour exhibits a softer nature than does malignant tumour but does not have a different SE pattern from other benign tumours. SE features of epidermoid tumour might be helpful in differentiating from other benign and malignant tumours.

To describe the histopathologic spectrum and patient characteristics of eyelid tumors in Beijing Tongren Hospital. It was a claims database analysis. A total of 2639 eyelid tumors verified histopathologically from January 1997 to December 2006 were included in the study. Of the 2639 eyelid tumors, the 5 most common eyelid benign lesions were inflammatory lesion, melanocytic nevus, papilloma, dermoid cyst and epidermoid cyst, and epithelial cyst. The 5 leading eyelid malignant tumors were basal cell carcinoma, sebaceous gland carcinoma, lymphoma, squamous cell carcinoma and melanoma. The mean age at diagnosis was 61 years for basal cell carcinoma and sebaceous gland carcinoma, 57 years and 52 years for squamous cell carcinoma and melanoma, respectively, and 48 years for lymphoma. There was no significant sex predilection in basal cell carcinoma and sebaceous gland carcinoma. Melanoma and lymphoma occurred more commonly in women, whereas squamous cell carcinoma occurred more commonly in men. Basal cell carcinoma and sebaceous gland carcinoma were the most common malignant eyelid tumors, and lymphoma ranked third and had an increasing trend. The malignant tumors occurred predominantly in the elderly of 60 years and above.

To study the argyrophilic nucleolar organizer region (AgNOR) count and subjective AgNOR pattern assessment (SAPA) score in cytologic and histologic specimens of various skin tumors. The study group consisted of 37 patients (14 benign and 23 malignant) of various skin tumors. In all cases, cytology by fine needle aspiration cytology (FNAC), and histological specimens were studied by conventional staining and silver staining for AgNOR. The mean count in benign tumors in cytologic specimens was 2.08 +/- 0.01, compared with 5.50 +/- 1.12 in malignant tumors (P<0.001). In histologic specimens, mean count was 2.13 +/- 0.51 in benign, compared with 5.38 +/- 1.10 in malignant tumors (P<0.001). The SAPA score in benign tumors (P<0.001) in cytologic specimens, was 6.07 +/- 0.83, compared with 10.65 +/- 1.27 in malignant tumors, and in histology, it was 6.07 +/- 0.87 in benign, compared with 10.83 +/- 1.15 in malignant tumors (P < 0.001). Melanoma showed the higher AgNOR count compared with squamous cell carcinoma and basal cell carcinoma. The parameters were statistically significant between the grade of tumor in squamous cell carcinoma and the positivity of lymph nodes as demonstrated by SAPA score. No correlation was found between the clinical stage and Clark level of melanoma. Although, AgNOR count and SAPA score showed similar results, the indicators of validity were higher in SAPA than AgNOR count. Although, AgNOR count and SAPA score gave similar results, but the indicators of validity were higher in SAPA score than AgNOR count.

Introduction: Skin tumors arise due to proliferation of group of cells having differentiation towards single or multiple components of skin. Based on their primary site of involvement, they can be divided into neoplasms with epithelial differentiation, melanocytic neoplasms, soft tissue neoplasms, neural tumors and tumors of subcutaneous tissue. Aims: 1. To evaluate the demographic and clinico-pathological patterns of tumors, tumor like lesions & cysts of epidermis and its appendages; 2. To compare the profile of patients with appendageal tumors against the total epidermal tumors. Materials and Methods: Prospective study, from July 2012 to November 2014, done at tertiary care center. Results: During the period of three years, there were 306 cases which presented as skin tumors and out of these, 57 happened to be cysts and the remaining 249 were tumors of skin. Out of 249 cases, 205 were diagnosed as benign, 23 were of premalignant and 21 as malignant tumors of skin constituting 82.32%, 9.24% and 8.43% respectively. There was male predominance with male to female ratio of 1.28:1. In this study benign keratinocytic tumors formed majority (49.27%) followed by melanocytic (31.32%) and appendageal tumors (10.44%). Among keratinocytic tumors maximum cases were of seborrheic keratosis (32.19%), among melanocytic tumors maximum cases were of acquired melanocytic nevus (21.40%) while nevus sebaceous (4.87%) formed majority among appendageal tumors. In present study malignant keratinocytic tumors formed majority (95.23%) followed by melanocytic (4.76%). Among keratinocytic tumors maximum cases were of BCC (57.14%). Conclusion: The diagnosis of skin tumors presents unique difficulties due to wide variety of tumors and the complicated nomenclature. The study of the adnexal tumours is interesting, fascinating and challenging because of wide range of differentiation. Keywords: Skin tumours, Benign tumors, Cysts, Benign keratinocytic tumors, Melanocytic tumors, Appendageal tumors

To determine the morphological pattern of parotid tumours. Case series. ENT Department of Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, from 1990 to 2004. During this study, 204 patients with parotid tumours were registered. The patients of all ages and both gender were included in this study. All patients were evaluated by history, clinical examination, F.N.A.C. and ultrasound, C.T/MRI was done in selected cases. All patients were surgically managed and their tumour specimen was sent for histopathology. Classification of individual tumour was based on 1991 World Health Organization Classification. Discrete data was presented in percentage and proportions. Out of 204 cases, 152 (74.5%) were benign and 52 (25.5%) were malignant. Of these, 117 (57.35%) patients were females and 87 (42.65%) males. Benign tumours were more common in females whereas malignant tumours were common in males. The mean age of patients was 34 years and 42 years for benign and malignant tumours respectively. Pleomorphic adenoma was most common benign tumor (83.5%), followed by Warthins tumour. The most common malignant tumour was mucoepidermoid carcinoma (60%), followed by adenoid cystic carcinoma. Superficial lobe of parotid gland was the commonest site, 120 benign and all 52 malignant tumours arising from it while 32 benign tumours originated from deep lobe. Parotid swelling for years was main feature of benign tumours, whereas malignant tumours presented with pain, fixation to skin or underlying structure, cervical lymphadenopathy and facial palsy. Pleomorphic adenoma was the most common benign tumour and mucoepidermoid carcinoma was most common malignant tumour. The morphological patterns and distribution followed the known pattern.

Objective To study the value of time intensity curve of contrast enhanced ultrasound in the discrimination of benign and malignant soft tissue tumors. Methods Thirty-seven cases of soft tissue tumors were carried out contrast-enhanced ultrasound examination. The region of interest in the dynamic images were chosen to carry out Gamma-Variate curve fitting through Q-LAB software and made a quantitative analysis. Then they were compared with pathological diagnosis to analyze the ultrasound imaging performance of benign and malignant tumors and their characteristics of micro-irrigation. Results Thirty-seven cases of soft tissue tumors were pathologically diagnosed 21 cases of benign and malignant in 16 cases. The perfusion of benign tumors were mainly uniformity (19/21) or potentialization (2/21). The perfusion of malignant tumors were mainly uniformity (10/16) or nonuniformity (6/16). There were no significant differences in time to peak(TTP) and arrival time of contrast agent(AT) between benign and malignant tumors( P ＞0.05). The upslope rate(A) and the derived peak intensity(DPI) in benign group were significantly less than malignant group ( P ＜0.05). Conclusions Time-intensity curve analysis of contrast-enhanced ultrasound showed that benign and malignant soft tissue tumors were different in perfusion,and it will be of a certain value for the clinical differential diagnosis. Key words: Ultrasonography; Microbubbles; Soft tissue neoplasms

Objective: We aimed to identify and describe the clinical and histopathologic characteristics of conjunctival neoplasms. Methods: Retrospective case series study. We collected and analyzed the clinical and histopathologic data of the conjunctival neoplastic specimens including the age, gender, and histopathologic diagnosis of all patients obtained from Beijing Tongren Eye Center between October 2003 and October 2015. All the pathology diagnosis results were divided into two categories which were benign and malignant tumors, according to Shields histopathological classification methods and the pathology diagnosis results in our department. All cases were divided into four groups as 0-17 years old, 18-39 years old, 40-59 years old, aged 60 and above. The chi-square test was used for statistical analysis. Results: Of the 2 053 cases, 1 025 were males and 1 028 were females (male∶female=1∶1). 1660 cases (80.9%) were benign and 393 cases(19.1%) were premalignant or malignant. The average age at diagnosis was 30.5 years for benign lesions and 53.3 years for premalignant and malignant lesions, which was significant different (P<0.01). The most common benign lesions were nevus, cysts, dermoids and dermolipomas, inflammatory granulomas and squamous cell papillomas. The most common premalignant and malignant tumors were CIN, melanomas, lymphomas and squamous cell carcinoma. The constitution of males and females of cysts, squamous cell papillomas, primary acquired melanosis, CIN and lymphomas were significant different (P<0.01). Moreover, the most common benign and malignant neoplasm were dermoids and dermolipomas, melanomas respectively in group under 18 years old. And nevus and lymphomas were the most common benign and malignant tumors respectively in patients between 18 and 39 years old. While cysts and CIN were the most common benign and malignant tumors respectively in cases over 40 years old. Conclusions: The majority of tumors of the conjunctiva were benign, with the young people being most. The premalignant and malignant tumors were more frequent in the elderly. Nevus and CIN were the most common benign and malignant tumors, respectively.(Chin J Ophthalmol, 2016, 52: 738-744).

Incidental histopathologic patterns: possible evidence of 'field cancerization' surrounding skin tumors.

Recently, an increased expression of P16, a cell cycle regulatory tumor suppressor protein, has been demonstrated in cervical squamous neoplasms as a marker of malignancy. In contrast, studies performed in skin carcinomas led to contradictory results. Our first aim was to evaluate P16 expression in different types of non-melanoma skin cancers compared with normal skin and benign tumors. The second aim was to evaluate the relationship between P16 expression and the location of skin tumors (i.e. exposed versus non exposed sites). Finally, we also studied Ki67 expression in skin carcinomas and control biopsies. Skin biopsy specimens with typical histologic features of squamous cell carcinoma (SCC; n = 30), Bowen's disease (BD; n = 17), basal cell carcinoma (BCC; n = 10), seborrheic keratosis (SK; n = 10) and normal human skin (NHS; n = 9) were obtained from 76 patients seen at our institution between 2001 and 2003. In all cases, P16 and Ki67 expression were evaluated by immunohistochemistry and image analysis. P16 overexpression was observed in 58% of cutaneous carcinomas (SCC: 60%; BD: 58%; BCC: 50%) versus 0% of SK or NHS (0%) (p = 0.006). Ki67 expression in over 5% of tumour cells was observed in 69% of cutaneous carcinomas (SCC: 54%; BD: 76%; BCC: 80%) versus 16% in the group including SK (30%) and NHS (0%) (p = 0.04). Overexpression of P16 was associated with a high rate of Ki67 positive tumour cells in 23/57 malignant skin tumors (40%). Both P16 was associated and Ki-67 were negative in 7/57 cases (12%). Sixty-eight percent of tumors located on sun-exposed areas versus 23% of those located on non sun-exposed areas overexpressed P16 (p = 0.02). Our study demonstrated that the expression of P16 and Ki67 is associated with skin carcinomas. No difference was observed according to histological types of carcinomas, suggesting that P16 and Ki67 expression did not correlate with the degree of proliferation and malignancy. Within cutaneous carcinoma specimens, P16 overexpression was significantly associated with the location on sun-exposed areas, suggesting a possible induction of P16 overexpression by UV radiation.