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Ovarian tumours are commonly seen in reproductive age group in women. However, when they occur at extremes of age, the suspicion of malignancy increases. The detection of dermoid cyst at 56 years of age is uncommon, hence proper imaging with CA-125 level monitoring is essential. Awareness of benign tumours or rare possibility of malignant transformation in such age is mandatory for surveillance management or planning the surgical procedure.

Most of the parapharyngeal space tumours are benign. The primary treatment is complete resection of the tumour. Due to its location in the deep neck space, a pre-styloid tumour can be resected via the transoral approach. However, the surgical field is limited by the small oral cavity. With the use of rigid endoscopes, removing benign tumours through transoral approach in the parapharyngeal space is possible as they provide a broad and enlarged view of the confined space. Here, we report a case of a 64-year-old male with a giant pre-styloid parapharyngeal space tumour, who successfully underwent transoral endoscopic excision. Postoperatively, the patient had short hospital stay of total 3 days. His chewing and swallowing were not affected, and he resumed oral feeding prior to discharge.

Objective To evaluate the precision and utility of fine-needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes. Design Retrospective case series. Setting Tertiary medical centre. Participants All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014. Main outcome measures Differences in clinical management and outcomes of patients with parotid masses in light of FNA results. Results We analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false-positive and false-negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low-grade, conversely non-diagnostic FNA for malignant tumours resulted in decreased survival. Conclusions Our findings highlight the limitations of FNA as a decision-making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.

Background Diagnosis of minor salivary gland (MSG) tumours is often difficult, due to the scarce tissue obtained from bioptic excision and complex histopathological differential diagnosis. In our study we performed an immunohistochemical analysis of PLAG1, HMGA1 and HMGA2 on a series of MSG tumours, in order to develop a new helpful diagnostic panel. Methods A retrospective series of 17 surgical specimens of MSG tumours were analysed for the expression of PLAG1, HMGA1 and HMGA2. Three control cases were enrolled and analysed. An intensity and percentage-based approach was performed, creating a combined score panel. Results PLAG1 facilitate the diagnosis of benign tumours, discriminating it from malignant histotypes, with a defined cut-off value. Similarly, HMGA1 is significantly higher in benign histotypes than in malignant ones. HMGA2 in our series, did not reveal any association in identifying benign from malignant histotypes. Conclusions In this study we assessed the diagnostic role of PLAG1, HMGA1 and HMGA2 immunohistochemical analysis. The score panel facilitate histopathological diagnosis of these rare tumours, helping to distinguish benign tumours from malignant ones and ameliorating the differential diagnosis of specific histotypes.

Background: There has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary. Objective: The objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria. Methods: A retrospective review of the histopathology register over the period January 2006 to December 2015. Results: The total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 – 12 years (mean 6.1years ± 3.97 SD). The age group 2 - 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%). Conclusion: Benign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information. Keywords: Childhood tumours; spectrum; haemangioma; lymphoma.

Adult-type rhabdomyoma (ARM) is the most frequent extracardiac subtype of rhabdomyoma. In very rare instances ARM presents as multiple cervical lesions, an entity known as multifocal ARM. The aim of this study was to review the clinical characteristics and the best therapeutic options for multifocal ARM. The case of a 73-year-old patient recently diagnosed with multifocal ARM and managed in our institution is reported, followed by a systematic review of the literature. The review was conducted using the PubMed, Scopus, and Google Scholar databases, according to the PRISMA guidelines. All case reports and case series related to multifocal ARM written in English or French were included. A total of 29 cases were included in the qualitative analysis. Mean age at presentation was 65.0 years and the male to female ratio was 13.5:1. Dysphagia was the most common presenting symptom. ARM was most frequently found in the submandibular spaces. In conclusion, multifocal ARM are benign tumours with a predilection for the head and neck region. They become symptomatic with gradual compression of the adjacent structures. No cases of malignant transformation were reported in the literature. We suggest a ‘watchful wait’ approach for small asymptomatic tumours and excision of large symptomatic ones.

Renal angiomyolipomas are the most common benign tumours of the kidney accounting for up to 1% of all renal masses. Giant angiomyolipomas which have a size greater than 10 centimetres are rare entities with few cases reported in literature. Small angiomyolipomas are usually a symptomatic and increasing size correlates with symptomatology. These are usually incidentally detected or when symptomatic may present with an abdominal lump, flank pain or hemorrhage. Herein, we report a rare case of 45-year-old lady with giant angiomyolipoma with clinical presentation indistinguishable from perinephric abscess. The case is rare with regards to the large size of tumour and the discordant presentation unusual for an angiomyolipoma.

BACKGROUND Fine needle aspiration cytology (FNAC) is commonly used as a safe and minimally invasive diagnostic test in benign salivary gland lesions. Nevertheless, the capacity of aspiration cytology in diagnosing benign lesions in the salivary gland is still disputed because accurate tumour typing is dependent on the quality and yield of the aspirate, as well as the competence of the cytopathologist. We aim to assess the precision of fine needle aspirate in the pre-operative diagnosis of benign salivary gland lesions and compare it with the histopathological findings. METHODS This is a longitudinal study conducted among 45 patients with preoperative cytological diagnosis of benign salivary gland lesions, who were followed-up till surgery with subsequent histopathological examination in Government Medical College, Thrissur, from 1 st January 2013 to 30th June 2015. RESULTS Among the benign neoplasms, 29 out of 30 cases of pleomorphic adenoma were confirmed on histopathology and one was basal cell adenoma. Out of nine cases of Warthin’s tumour, only seven were confirmed by histopathology. Of the remaining two, one was found to be salivary duct carcinoma showing the typical comedo necrosis and the other was found to be low grade mucoepidermoid carcinoma. So, these two cases were found to be false negative. The statistical analysis showed an overall diagnostic accuracy of 95.5 % for benign salivary gland lesions. CONCLUSIONS FNAC is a minimally invasive technique useful in salivary gland lesions. In nonneoplastic lesions surgery can be avoided and in neoplasms appropriate surgery can be planned. An accurate cytological diagnosis is often possible but may sometimes require the expertise of the cytopathology and use of ancillary techniques KEYWORDS Salivary Gland, Fine Needle Aspiration Cytology, Benign Tumours, Pleomorphic Adenoma, Warthin’s Tumour, Mucoepidermoid Carcinoma, Salivary Duct Carcinoma

Ovarian tumours are common neoplasms in females and have diverse histopathological entities as they are derived from different cells of origin. Histopathological patterns and incidence of 121 ovarian tumours were studied in Department of Pathology, JJMMC Davangere, during the period from January 2015 to December 2016. The age of the study subjects varied from 15 to 65 years, and the most common age group was between 31-40 years. Among the ovarian tumours 70.30% were benign neoplasms and 29.3 were malignant. The most common among the ovarian tumours was surface epithelial tumours which constitutes 74.4% of all ovarian tumours followed by germ cell tumours constituting 18.8% of all cases. The determination of these patterns is important for diagnosis, management and prognosis. Keywords: Benign tumours, Germ cell tumours, Malignant tumours, Ovarian tumours, Surface epithelial tumours.

Purpose of the study . The primary study presents an analysis of the results of stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (SRBT) of extra — and intracranial tumors obtained during four years of observation at «National Medical Research Centre for Oncology». Material and methods. The study enrolled 277 patients. 184 patients (66.4%) received SRS, 54 patients (19.5%) received intracranial SRT, 39 patients (14.1%) received extracranial SRBT. Radiation treatment plans were developed with iPlan and Elements planning software, BrainLab. Radiation therapy was performed with Novalis Tx, Varian linear accelerator. Outcome assessment was performed with iPlan and Elements software, BrainLab, by comparing tumor volumes based on brain MRI series for brain tumors (or CT imaging for extracranial pathology) before the treatment and during four-year follow-up. Stereotactic radiosurgical and hypofractive radiotherapy techniques were used. In radiosurgical surgery, radiation therapy was performed with a single high-precision approach of the therapeutic dose to the target for the purpose to reach biological effect in the irradiated volume with minimal impact on the surrounding tissues. Single focal doses (SFD) were selected due to histology, and the dose was prescribed according to the accepted criteria of The International Commission on Radiation Units and Measurements (ICRU) (2010) Report 83. Hypofractionated stereotactic radiotherapy was performed using 2-5 Fractions (FR) with an average range of 3-10 Gy. Results. During the entire period of observation tumor volume and clinical symptoms in patients who received SRS were reported to reduce in 69,8%, to be stable in 19,6%, increased in 9,8%, respectively. For patients, who received intracranial SRT, tumor volume and clinical symptoms were reported to reduce in 59,3%, increased in 21,4%, to be stable in 9,3%. For patients with extracranial tumors, who went SRBT, tumor volume and clinical symptoms were reported to be stable in 58,9%, reduced in 38,5%, increased in 6,7%. Conclusion. The analysis of the obtained data shows the high efficiency of SRS and SRBT methods, which allow to achieve local control over both malignant and benign tumours.

Background Infantile haemangiomas are the most common benign tumours affecting infants. Over time, the tumours may involute to some extent. However, sequelae, such as telangiectasia or fibrofatty tissue, often occur following this condition, which may cause disfigurement and influence patients' psychosocial development. Objective This prospective, randomized, self-controlled study aimed to assess the effects of topical timolol (0.5%) on involuting infantile haemangiomas. Materials & methods Each involuting superficial infantile haemangioma (n = 29) was randomly divided into two regions; one region was treated with topical timolol (0.5%) cream, three times daily, and the other region was untreated. The comparative treatments continued for three months. Five independent assessors, blinded to the treatment regimen, judged the treated and untreated regions by comparing photographs before and after treatment. Results The topical timolol-treated tumour sections showed no difference compared with the untreated sites (p = 0.355) after three months of treatment, and by the end of the treatment, the untreated lesions showed significant differences relative to pre-treatment (p Conclusion Topical timolol was not observed to have any effect on the regression of infantile haemangiomas in the involuting phase.

Objective Cervical spine osteochondromas are rare with approximately 3% of solitary and 7–9% of hereditary osteochondromas occurring in the spine. Almost 50% of spinal osteochondromas occur in the cervical region. Methods A search of osteochondroma of cervical spine was performed of our radiology database. Results In this study, we present 11 cases of adult cervical spine osteochondromas. These predominantly involved the posterior elements. The cartilage cap was more than 2 cm in 2 cases. There was cord compression in 1 case, foraminal narrowing in 2 patients and vertebral artery compression in 1 case. 6 patients underwent excision with majority being osteochondroma. There was only one case of chondrosarcoma. Conclusion Osteochondromas of cervical spine and extremely rare and symptomatology are due to mass effect. One should be aware of this entitly when analysing cervical spine for neck pain or lump.

Haemangiomas of the liver are benign tumours, which are often diagnosed randomly. With an increase in size haemangiomas could become symptomatic. In this case therapeutic options, surgical or interventional, have to be weighted to a conservative approach. We present a case of a 36-year old woman with a symptomatic giant haemangioma of the right liver lobe. Because of the size of the tumor and the small future liver remnant we decided to perform a major liver resection after hypertrophy induction with a preoperative portal vein embolization; an option mainly used for major hepatectomies in malignant tumors of the liver. But however, this case shows, that using a hypertrophy concept also for benign liver tumours is the safer approach, if an extended resection is necessary and the future liver remnant is critical.

Background: Fibro-epithelial polyps (FEPs) of the ureter are rare benign tumours and constitute an important differential for ureteral urothelial cell carcinoma (UCC). Case presentation: We describe a case of a 56-year-old lady presenting with gross haematuria. On initial evaluation elsewhere, she was diagnosed with lower ureteric UCC and was advised left nephroureterectomy. Careful evaluation at our centre established the diagnosis of a left ureteral FEP. Robot-assisted excision of the ureteral FEP was successfully done. Conclusion: Diagnosis of these rare tumours may be made with a combination of imaging, ureteroscopy and histopathological analysis. Resection of giant FEPs may be done with a robot-assisted technique. Proper diagnosis and management of these tumours are essential to avoid unnecessary nephroureterectomies. Level of evidence: 4

Introduction Wide excision margins are traditionally recommended for phyllodes tumours of the breast to reduce recurrence. Recent studies suggest margin status and histopathological features, excluding margin width, influence recurrence. This study evaluated treatment outcomes for phyllodes tumours and examined predictors of recurrence. Methods Clinical and follow-up information for phyllodes tumours patients treated between 2008 and 2017 were obtained from chart review. Tumour subtype and histopathological features were determined from pathology reports. Primary endpoints were recurrence rate and time to recurrence or mortality. Results Among 96 patients, there were 6 local and 1 distant recurrences. Overall recurrence rate was 7.3% and average time-to-recurrence was 13.7 months. Tumour size, margin status, necrosis, and mitoses were associated with recurrence; margin width was not. Two deaths (2.1%) from malignant phyllodes occurred. Conclusions Multiple histopathological features influence phyllodes recurrence. Wide excision and re-excising positive margins for benign tumours was not beneficial.

Background Primary bone tumours of the talus are a rare entity and seldom described in the literature. Due to this, often the diagnosis and management of such cases are delayed. This study aims to describe a spectrum of lesions identified within our department and provide a pictorial review with the goal to aid radiologists in the evaluation and diagnosis of such lesions. Materials & methods A retrospective study was conducted within our department, identifying all talar lesions, confirmed on histopathological and radiological diagnosis. Results Results revealed 75 cases of talar lesions. Benign tumours formed the bulk of the lesions identified accounting for 85% of all cases. The most common benign tumour was chondroblastoma (n = 23). Malignant tumours were detected in 6 cases. Other lesions included osteomyelitis and avascular necrosis. Conclusion We present a variety of tumours and tumour-like conditions of the talus. Radiologists as well as orthopaedic surgeons need to be aware of such lesions, to prompt early diagnosis and initiate management in timely fashion.

Fibroids are uterine smooth muscle tumours which are commonly found. They can vary in their number, location and size. Depending on the location and the size fibroids can be symptomatic. Symptoms can be menstrual dysfunction, pressure or subfertility. The treatment strategies will depend on the patient's characteristics, of which the most important is the wish to preserve the uterus. In this review all treatment modalities will be discussed with their risks. Clinicians need to be aware of the very rare risk of these benign tumours developing into malignancy.

Meningiomas are mostly regarded as benign tumours, accounting for 13% to 26% of all primary intracranial tumors1. According to 2016 World Health Organization (WHO) classification, meningiomas are classified into grade I (benign), II (atypical), and III (anaplastic).2 Meningioma are neoplasms derived from arachnoidal (meningothelial) cells. These lesions can occur in people of any age but commonly present in middle age. Women are more likely to develop a meningioma, with a female/male ratio of approximately 2:1 intracranially and 10:1 in the spine.3 Even after complete removal, meningiomas have been estimated to recur in 10 to 32% of the cases within 10 years. However, recurrences in grade 1 meningiomas are rare and occur after long duration.4 We herein report a case of grade 1 meningioma that recurs very fast, within the duration of 1 yr and the recurrent size of the tumor was approx three times the size of the primary one. To our knowledge, very few cases in the literature have been reported with such a fast-growing grade 1 meningioma.

Infantile haemangiomas (IHs) are the most common benign tumours of childhood; despite the benign histology, prognosis depends on severity of visceral involvement, with a mortality rate ranging from 50 to 90%. In this paper, we describe two infants with multifocal infantile haemangiomatosis and hepatic involvement. This condition should receive appropriate management as it can be potentially lethal due to the high risk of systemic complications such as cardiac or fulminant hepatic failure and abdominal compartment syndrome. Both cases presented with liver involvement, but only the infant who had an excellent response to propranolol is still alive. A review of current therapeutic approaches is also presented even though there are, at present, no uniform guidelines for treatment, despite the relative frequency of infantile haemangiomatosis and the potential severe complications.

Benign tumours of the epididymis are rare, and the most common tumour types include adenomatoid tumours, representing more than half of all cases, and leiomyomas. Here, we reported a case of leiomyoadenomatoid tumours of the epididymis, a very rare, benign histological entity with only few cases described in the English literature, which have been reviewed and summarised. Clinically, the lesion presented as a solitary mass growing at the level of the tail of the right epididymis. After the intraoperative frozen section analysis revealed a benign adenomatoid lesion, the mass was enucleated with a conservative surgery sparing the testis. This case highlights the importance for both pathologists and urologists to be aware of these rare, but benign, tumours, to avoid misdiagnosis, especially in the setting of frozen intraoperative consultation, or primary radical surgical procedures, as radical orchiepididymectomy without frozen section consultation.

Contains fulltext : 251754.pdf (Publisher’s version ) (Open Access) The diagnosis and treatment of deep lobe parotid tumours is challenging because of the complex surgical accessibility. There is a lack of studies describing the differences between deep lobe tumours that do and do not occupy the parapharyngeal space (PPS). Patients treated for deep lobe tumours occupying the PPS (PPS group) and not occupying the PPS (non-PPS group) were analysed retrospectively. A total of 227 patients were treated surgically for deep lobe parotid tumours between 1990 and 2019. Sixty patients (26.4%) presented with tumours that involved the PPS (PPS group), while 167 (73.6%) presented with tumours that did not occupy the PPS (non-PPS group). The majority of the PPS group tumours were removed using a transcervical or transcervical-transparotid approach. PPS group tumours were larger (P < 0.001), and tumour spill occurred more frequently in this group (benign tumours: P = 0.002; malignant tumours: P = 0.033). Complication rates did not differ between the PPS and non-PPS groups. A transcervical or transcervical-transparotid approach is the preferred method for the management of deep lobe parotid tumours that occupy the PPS in our practice. Tumour spill occurred more frequently in the PPS group, which is most probably due to the larger tumour size and more complex accessibility.

Paragangliomas are benign tumours arising from neural crest cells and can be seen in various parts of the body. Larynx is an uncommon site for these benign tumours. Although most laryngeal lesions are managed endoscopically, histopathological examination might throw up a surprise lesion as paraganglioma, which tends to recur. One such recurrent case is reported here which was managed by an open non-endoscopic approach.

Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.Infantile Hämangiome (IH) sind die häufigsten gutartigen Tumoren des Augenlids und der Augenhöhlen im Säuglingsalter. Betablocker in Form von oralem Propranolol sind in schweren Fällen mit funktionell signifikantem oder entstellendem IH zur Erstlinienbehandlung geworden. Unerwünschte Arzneimittelnebenwirkungen von oralem Propranolol werden jedoch in 1 von 11 Säuglingen und schwerwiegende oder potenziell lebensbedrohliche Nebenwirkungen in 1 von 38 Säuglingen berichtet, einschließlich Dyspnoe, Hypotonie, Hyperkaliämie, Hypoglykämie und Zyanose, die daher eine sorgfältige und genaue Überwachung während der oralen Behandlung erfordern. In jüngerer Zeit haben 2 große Metaanalysen gezeigt, dass topische Betablocker wie Timololmaleat 0,5% bei oberflächlichem IH genauso wirksam sind wie orales Propranolol, jedoch ohne oder mit signifikant weniger Nebenwirkungen, und befürworten die Ersetzung von oralem Propranolol durch topische Betablocker als Erstlinienbehandlung von oberflächlichem IH. Wir haben bereits über das therapeutische Ansprechen von tiefen periokulären IH auf eine primäre topische Timololmaleat-0,5%-Monotherapie berichtet. Hier beschreiben wir die ersten erfolgreichen Behandlungen von großen orbitalen IH mit topischem Timololmaleat 0,5% bei 4 Säuglingen, was in allen Fällen zu einem sofortigen Ende des klinischen Fortschreitens und einer schnellen klinischen Verbesserung oder vollständigen Heilung führte. Bei keinem der Patienten, die mit topischem Timololmaleat 0,5% behandelt worden waren, wurden während der Behandlung Nebenwirkungen oder nach Beendigung der Behandlung während der Langzeitnachbeobachtung von bis zu 2,5 Jahren ein Wiederauftreten beobachtet.

Benign tumours and tumour-like lesions are occasionally seen in the intra-articular region of the elbow and clinically present with chronic disabling pain and progressive stiffness. Arthroscopic excision is possible when the lesion is focal and in an accessible location. This chapter presents the arthroscopic findings and technique for excision of three different intra-articular bony and soft-tissue lesions.

Granular cell tumours are uncommon acquired benign tumours of nerve sheath origin that are usually seen in the head and neck region and upper aero-digestive tract. They usually present as solitary small sized nodules in middle age. The tumour is usually benign and composed of sheets of large sized cells with abundant granular cytoplasm containing lysosomal macro-inclusions known as pustulo-ovoid bodies of Milian (POB) that represent the heterogeneity of the lysosomes. No well-established criteria for malignancy have been described for this tumour. In this article, we have discussed a rare case of granular cell tumour of the penis with its characteristic histomorphology and immunohistochemistry and relevant differential diagnosis.

Uterine leiomyomas are the most common benign tumours of the female genital tract that arise from smooth muscles and extracellular matrix. Up to 80% of leiomyomas occur during reproductive age grou...

Inherited thyroid tumours are an important group which need clarification. This is partly because of the common use of the term Familial Non-Medullary Thyroid Cancer when some of the specific entities included under this heading really represent inherited benign tumours with a risk of progression to malignancy. The subject is briefly reviewed, and one syndromic and one non-syndromic type of inherited thyroid tumours of follicular cell origin discussed in more detail to emphasise the point that each of these groups need to be treated as separate entities.

Benign parotid tumours usually present as a slow-growing, asymptomatic mass in the pre-auricular region. Although they are uncommon, surgical excision is the mainstay of treatment due to the risk of malignant transformation in some benign tumours. Surgical techniques have evolved over the years, with superficial parotidectomy and extracapsular dissection being the current procedures of choice. There is currently no gold standard, and it remains unclear which surgical modality is the superior option. A literature review was performed in relation to the relative merits of each technique and to evaluate the reasons underpinning the ongoing debate. A total of 16 papers comparing the main clinical outcomes of the procedures were critically reviewed using the PRISMA protocol. Overall, extracapsular dissection indicated a reduced recurrence rate, facial nerve paralysis, Frey syndrome, and operation time. The superior outcomes following extracapsular dissection could be attributed to the less radical nature of the procedure. However, there were various limitations identified within the review that may have affected the results. Selection bias was the most significant, with patients assigned to the different procedures depending on the tumour size and location. Consequently, the debate continues as to what constitutes the gold standard of care for benign parotid tumours.

Background: Breast tumours are very common cause of morbidity and mortality worldwide specially in developing countries. Breast lesions show broad spectrum of disease patterns in respect to benign, malignant, and non-neoplastic. Breast cancer is one of the most frequently occurring cancer among women. Objective: To study the frequency, age distribution, clinical and histological patterns of neoplastic and non-neoplastic lesions of breast in this rural population. Material and methods: This observational study was conducted over a duration of three years. In which we studied 210 cases of breast lesions. Specimens were received in department of pathology. Grossing, tissue processing, staining done according to standard protocol. Haematoxylin and eosin (H&E) stained sections were examined under microscope to categorise different type of lesions in the form of non-neoplastic and neoplastic. Results: Out of 210 breast lesions, fibroadenoma was the commonest (114 cases) benign lesion. While invasive ductal carcinoma (70 cases) was commonest in malignant category. Non neoplastic lesions stand on third place, study showed 6 cases out of 210 total cases, in which acute mastitis (4 cases) was most common. Benign tumours were mostly seen in 2nd and 3rd decade and malignant tumour mainly in 5th and 6th decade Conclusion: Early histopathological diagnosis of breast lesions is very important to differentiate between benign and malignant lesions. Large number of cases of invasive ductal carcinoma (>33% of all cases) were seen in our study, which is a serious concern. So, generation of awareness among women is need of time to reduce the morbidity and mortality specially in Indian rural setup

Meningiomas are generally slow-growing extra-axial benign tumours and in rare cases they can metastasize both neural and extra-neural. Intracranial meningiomas with leptomeningeal dissemination are extremely rare and the exact pathogenesis still remains unknown. The aim of this review is to analyse the pathways of intracranial and spinal metastatic spread of intracranial meningiomas and to discuss their particular clinical and pathological features. We highlight the fact that there is a possibility of leptomeningeal dissemination, even if cerebrospinal fluid cytology is negative, in patients with a medical history of a resected meningioma. We identified three possible ways of dissemination: haematogenous, through the CSF, or during surgery. From a histopathological point of view, the more malignant the meningioma, the more likely its leptomeningeal dissemination.

Objectives The aim of this study was to investigate the hypothesis of whether extracapsular dissection (ED) of the parotid gland increases the need for revision surgery for benign tumours in comparison to traditional surgical modalities. A further aim of this study was to evaluate and compare the functional outcome of revision procedures after primary ED with other modalities involving the parotid gland in our department. Materials and methods All patients who underwent revision parotid surgery after a primary surgical procedure at a tertiary care hospital (University of Erlangen-Nurnberg) between 2000 and 2016 were included in our study. Data concerning the indication for revision surgery as well as the functional postsurgical outcome were obtained. Results 2465 cases formed our study sample. In total, revision surgery was necessary in 30/2465 cases (1.2%). 1532 patients underwent primary ED, with 17 cases requiring revision (1.1%), whereas 933 cases were managed by means of other facial nerve dissecting surgical modalities, with the indication for revision surgery in 13 cases (1.4%). Our analysis did not reveal a statistically significantly higher need for revision surgery or a higher rate of facial nerve palsies after revision surgery in the group of patients after primary ED. Conclusion The argument in favour of a greater need for revision surgery after primary parenchyma-sparing modalities was not sustained from our data. Due to the low revision rate and the acceptable functional results after revision surgery, we believe that extracapsular dissection is justified in cases where a benign lesion is suspected preoperatively.

Introduction: Cervical swellings and lumps are common clinical problems. Neck swellings in children are commonly congenital and benign tumours while neck swellings in adults should be aimed to exclude malignancy. FNAC is the single most important test in the evaluation of neck swellings especially metastatic lymph nodes. FNAC helps in planning out surgical management of neck masses which can be confirmed with histopathology which is the gold standard for diagnosis. Objective: The aim of the study was to evaluate the various swellings in the neck and to compare the findings of FNAC and HPE. Material and Methods: The study is a prospective study conducted over a period of two years from January 2016 to January 2018 in the Department of ENT and Department of Pathology in Bundelkhand Medical College Sagar M.P. The study involved 100 cases of patients with neck swellings who attended ENT OPD and gave consent for both FNAC and biopsy or excision biopsy and HPE. Results: The overall accuracy of FNAC in diagnosing neck swellings is similar to that of HPE. Conclusion: FNAC is an important preoperative tool in the diagnosis of various neck swellings of the neck and is recommended as the first line of investigation in various neck swellings.

The aim of this study was to evaluate the potential of watchful waiting in the treatment of metachronous cystadenolymphomas, taking the experience of our department into consideration. All patients suspected of having a metachronous cystadenolymphoma, and who had a minimum follow-up time of 12 months, were studied (n = 26). Data about the growth rate, number of lesions, and symptoms of inflammation were recorded. Mean (range) follow-up was 36 (13–94) months. Metachronous tumours developed in three cases on the ipsilateral side, in 22 cases on the contralateral side, and on both sides in one case. The mean rate of growth /lesion was 15% /year (range: 22%–158%). There were no signs of local inflammation. The extreme variability in the behaviour of metachronous cystadenolymphomas points to the need for an individualised approach, accurate investigation of the sonographic characteristics, and continuous watchful waiting in affected patients.

Although uterine myomas are the most common benign tumours of the female pelvis in the reproductive age group, they rarely grow in menopausal women. Parasitic fibroids without prior history of laparoscopic myomectomy are even a rarer presentation particularly in menopausal women. The case presented is a 58-year-old grand-multiparous, menopausal lady with progressive abdominal swelling of three-year duration. She had excision of a huge parasitic fibroid attached to omentum. She had partial omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. The parasitic fibroid mass weighed 5.2kg and histopathology confirmed leiomyoma uteri with cystic degeneration and lymph nodes with reactive lymphoid hyperplasia. She had uneventful postoperative recovery and follow-up has so far been uneventful.

Utilizzo di una guida CAD-CAM per la preservazione del nervo alveolare inferiore durante le resezioni mandibolari nelle lesioni benigne.Durante le procedure chirurgiche di resezione mandibolare, la preservazione del nervo alveolare inferiore (NAI) è auspicabile nella patologia benigna. In questo studio pilota prospettico, riportiamo la nostra esperienza nell’uso di una dima di taglio customizzata per la rapida preservazione del nervo alveolare inferiore (RICS). La pianificazione chirurgica virtuale della guida di taglio è basata sul modello 3D ottenuto dall’elaborazione dei file DICOM della TC pre-operatoria. Sono stati inclusi nel nostro studio 5 pazienti affetti da patologia mandibolare benigna. Sono stati esteriorizzati in totale 7 NAI. Il tempo medio di esteriorizzazione è stato 23 minuti. Tutte le esteriorizzazioni sono state eseguite con successo e non è avvenuto alcun danneggiamento del fascio neuro-vascolare. Tutti i pazienti hanno mostrato il recupero completo della sensibilità del NAI entro 7 settimane dall’intervento chirurgico. In conclusione, la dima di esteriorizzazione RICS sembrerebbe permettere una più rapida e sicura preservazione del NAI.During surgical procedures involving the mandible, preserving the inferior alveolar nerve (IAN) may be preferable for benign tumours. In this prospective pilot study, we report our experience on the use of a Rapid Inferior Alveolar nerve Customised Salvage (RICS) template. Virtual surgical planning (VSP) of the template is based on a 3D model obtained from the elaboration of DICOM files of the preoperative CT scan. Five patients affected by benign mandibular pathology were included. A total of 7 IANs were exteriorised. The average time of exteriorisation was 23 minutes. All exteriorisations were performed successfully and no damage to the neuro-vascular bundle occurred. All patients showed complete recovery of sensitivity of the IAN within 7 weeks after surgical procedure. In conclusion, RICS template seems to allow faster and safer exteriorisation of the IAN.

AIM To investigate the optimal combined 2-[18F]-fluoro-2-deoxy- d- glucose (FDG) positron-emission tomography (PET)/computed tomography (CT) diagnostic criteria for distinguishing between benign and malignant retroperitoneal soft-tissue masses (RPMs). MATERIALS AND METHODS A total of 74 patients (M:F=34:40; age, 53±13.2 years) who underwent FDG PET/CT for the initial work-up of RPMs were included. The maximum standardised uptake value (SUVmax), tumour size, presence of fat or calcifications and separated hypermetabolic lesions were included as PET/CT diagnostic parameters. Receiver-operating characteristic (ROC) curves were used to compare the diagnostic performance. RESULTS The final pathological diagnoses included 52 malignant and 22 benign tumours. High SUVmax (>4.8) and large size (>13 cm) favoured malignancy, and yielded a diagnostic accuracy and AUC of 64.9%, 0.820±0.059, and 68.9%, 0.738±0.061, respectively. In a subgroup of RPMs with a fat component, both SUVmax and size were significantly different between benign and malignant RPM, which yielded a diagnostic accuracy and AUC of 91%, 0.977±0.024 (cut-off, 1.9 cm) and 87.9%, 0.865±0.072 (cut-off, 13 cm), respectively. In a subgroup without a fat component, only SUVmax was significantly different with an accuracy of 90.2% and AUC of 0.919±0.043. The optimal diagnostic flow by combining SUVmax and tumour size after dividing patients into two groups according to the presence of fat showed a sensitivity of 90.4%, a specificity of 95.5%, and an accuracy of 91.9%. CONCLUSIONS The combination of SUVmax and size according to the presence of a fat component may be the optimal PET/CT diagnostic criteria for distinguishing benign and malignant RPMs.

ObjectiveSinonasal inverted papillomas are challenging benign tumours of the nasal cavity because of their high recurrence rates and the lifetime malignant transformation risk of 10 per cent as well as their locally aggressive behaviour. This study aimed to describe treatment strategies for inverted papillomas with intracranial or intraorbital involvement.MethodThis was a prospective case series study of 18 patients with inverted papilloma with intracranial or intraorbital involvement. Patient demographic data, imaging, pathology, surgical technique and recurrences were recorded prospectively over a period of seven years.ResultsA total of 83 per cent of the patients in this study had been previously operated on, consisting of 8 cases with intracranial involvement, 1 case with intraorbital involvement and 9 with both. During follow up with a medium of 37 months (range, 13–115 months) there were two recurrences.ConclusionIt was postulated that intracranial or intraorbital involvement observed in this series was the result of multiple revisions. However, using accurate imaging protocols and the pedicle-oriented approach for tumour excision, complete tumour removal was achieved in most cases with minimal post-operative complications.

Introduction Odontogenic lesions are diverse and varied. Some of them, in addition to having a significant power of bone destruction, recur most often after surgical removal. This could be explained by moleculoskeletal mechanisms that have not yet been mastered. Hence the initiation of the present work whose objective was to study the genetic and malecular anomalies of maxillo-mandibular odontogenic cysts and benign tumours by a review of the literature. Material and method Search engines such as Pubmed, PMC, Google Scholar, Science direct, Journal of oncology were searched using key words with some filters. Results Out of a total of 162 articles consulted, 40 were retained. The analysis of the articles retrieved allowed us to gather the genetic and molecular anomalies involved in the pathogenesis and development of benign maxillomandibular odontogenic cysts and tumours, sometimes explaining the clinical behaviour of some of these lesions. In addition to the molecular and genetic alterations encountered in the key genes of odontogenesis, molecules inhibiting the activities of apoptosis proteins would be hyper-expressed in certain very aggressive odontogenic lesions with a recurrence capacity. Conclusion Knowledge of the molecular mechanisms involved in the pathogenesis and development of odontogenic lesions would allow the use of new therapeutic procedures in management of maxillo-mandibular odontogenic lesions.

Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.

Colonic lipomas are rare benign tumours, although they constitute the most common non-epithelial neoplasm of the gastrointestinal tract. They mostly remain asymptomatic and rarely present with intussusception. A 62-year-old male presented with acute intestinal obstruction. On laparotomy, intussusception of the descending colon was detected, with a single sessile polyp measuring 3 cm×3 cm as the lead point. A left hemicolectomy was performed, and histopathological examination revealed a lipoma of the colon.

Aim To characterise tumours that involve the neural foramina in children, including prevalence, demographics, and imaging features. Material and methods This retrospective single-centre study comprised 36 boys and 34 girls who presented with spinal or paraspinal lesions involving the neural foramina. Two certified radiologists reviewed the imaging features, including the level of spinal involvement, the number of involved foramina, foraminal widening, tumour epicentre, and cord compression. Medical charts were reviewed for patients' demographics and tumour pathology. Tumours were classified as benign or malignant, and neuroblastomas were further classified as low or intermediate risk versus high risk. Results Thirty-three (47%) of the patients had neuroblastic tumours. Fourteen (20%) of the patients had sarcomas (mainly Ewing sarcoma). Other less common aetiologies included neurofibromas, germ cell tumours, Langerhans cell histiocytosis and haemangiomas. Neuroblastic tumours were particularly common in the thoraco-lumbar region, and considerably less prevalent in the sacral and cervical regions. Additional features, such as foraminal widening, the number of foramina involved, and cord compression, did not help discriminate between neuroblastic and non-neuroblastic tumours. Most tumours (80%) were malignant. Most benign tumours (>50%) were associated with a genetic predisposition syndrome. Conclusion In evaluating neoplasms that involve the neural foramina in children, neuroblastic tumours are most common. Nevertheless, other aetiologies should be considered, mainly sarcomas. Most lesions in children are malignant. When encountering a benign mass, genetic counselling should be considered.