Uncommon Site Presentation: A Case Report of Extraparotid Warthin's Tumor.

Warthin's tumor, also known as adenolymphoma or papillary cystadenoma lymphomatosum, is a benign tumor almost exclusively found in the parotid gland and is the second most common type of benign parotid tumor. Its manifestation as an extraparotid lesion is rare, with a low incidence in the submandibular gland. In this context, we present a case of Warthin's tumor of the submandibular gland in a 66-year-old man who presented with a painless lateral cystic cervical mass. This case highlights the clinical and radiological evidence of an uncommon extraparotid tumor location, with the diagnosis becoming evident only after the enucleation of the mass. Despite the rarity of extraparotid Warthin's tumor and its potential variation in location, the authors recommend considering Warthin's tumor of the submandibular gland in the differential when assessing lateral cervical masses.

Utility of the Milan System for Reporting Salivary Gland Cytopathology in fine needle aspiration cytology of minor salivary gland lesions.

INTRODUCTION: Salivary gland lesions are routinely evaluated by fine-needle aspiration cytology (FNAC) preoperatively. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has standardized salivary gland FNAC reporting. Its application in major salivary glands (MSGs) has been well-established; however, its utility in minor salivary glands (MiSGs) is not well-known. We studied the utility of MSRSGC in MiSG FNAC. MATERIALS AND METHODS: A retrospective search of MiSG FNACs from 2 academic institutions (2006-2023) was performed. FNACs were classified using the MSRSGC. Histologic data were reviewed and recorded. The risk of malignancy (ROM), risk of neoplasia (RON), diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: The series included 43 MiSG FNAC (24 males and 18 females), with a mean age of 55 years (range 10-92). Aspirated sites included the following: palate, buccal space, floor of mouth, lip, tongue, and maxillary sinus. FNACs were classified as nondiagnostic (1), nonneoplastic (3), atypia of undetermined significance (6), benign neoplasm (9), salivary gland neoplasm of uncertain malignant potential (15), suspicious for malignancy, (2) and malignant (7). The risk of neoplasia and risk of malignancy were 87% and 39%. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, respectively. CONCLUSIONS: Milan System for Reporting Salivary Gland Cytopathology offers valuable information for stratifying MiSG lesions. However, the distribution and the range of diagnostic entities encountered differ somewhat from those in MSGs. For instance, mucinous cyst contents may warrant unique consideration in MiSG; while an atypical classification is recommended in MSGs, the high prevalence of mucoceles in MiSG may tilt this group toward benignity.

Mucoepidermoid microcarcinoma in the context of parotid gland cyst.

Mucoepidermoid carcinoma is a type of salivary gland cancer that can develop in the context of a parotid gland cyst. This type of tumor is composed of mucous, epidermoid, and intercalated cells, and usually presents as a slow-growing and painless mass. A parotid gland cyst is a condition in which a fluid-filled sac forms in the parotid gland. The tumor can be masked as it develops within the parotid cyst. A 45-year-old female patient presented with a suspect of benign neoplasm of the major salivary gland. She underwent partial right parotidectomy, which upon pathological analysis confirmed the diagnosis of mucoepidermoid microcarcinoma associated with parotid gland cysts. The patient did well and continues under regular follow-up with no further treatment.

A True Fibroma in the Hard Palate: A Report of a Rare Case.

The incidence of benign neoplasms is common in the oral cavity. Provisional diagnosis does not accurately identify rare neoplasms. With differential diagnosis of similar lesions and confirmation by histopathology, rare lesions can be identified. This case report also ended up to be a rare lesion of true fibroma in the palate through a histopathology report. Hence, the correlation of clinical findings to the confirmation with histopathology leads to a definitive diagnosis of uncommon lesions.

Calcifying Aponeurotic Fibroma of Leg Masquerading as Hemangioma in an Adolescent Male along with Review of Literature.

Calcifying aponeurotic fibroma (CAF) is a rare soft tissue tumor which falls under the WHO category of benign fibroblastic and myofibroblastic tumors. It typically occurs on the distal extremities (hands and foot) of children and adolescents. Other less common sites include wrists, ankles, trunk and rarely legs and arms. These tumors present as a painless soft tissue mass, arising in the subcutis, and are usually connected to tendons or aponeuroses. Computed tomography (CT) and magnetic resonance imaging (MRI) are the radiological investigations of choice; however, histopathology remains the diagnostic modality of choice for the diagnosis of CAF. We present a rare case of a 17-year-old boy who presented with a gradually progressive mass lesion on the leg which was later diagnosed as calcifying aponeurotic fibroma on histopathology.

Exposure to di-2-ethylhexyl phthalate and breast neoplasm incidence: A cohort study.

BACKGROUND: Phthalates are ubiquitous environmental endocrine disruptors. As the predominant phthalate, di-2-ethylhexyl phthalate (DEHP) has been considered possibly carcinogenic to humans but large-scale longitudinal evidence is needed to further clarify its carcinogenicity. OBJECTIVES: To examine the association between DEHP exposure and incidence of breast malignant neoplasm, carcinoma in situ and benign neoplasm. METHODS: A total of 273,295 women from UK Biobank cohort were followed up for a median of 13.5 years. Disease information was collected from National Health Service Cancer Registry and National Death Index. Baseline and yearly-average level of DEHP exposure were estimated for each individual by linking chemical monitoring record of European Environment Agency with home address of the participants by Kriging interpolation model. Cox proportional hazard model was employed to estimate the association between DEHP exposure and breast neoplasms. RESULTS: The median (IQR) of baseline and yearly-average DEHP concentration were 8000.25 (interquartile range: 6657.85-11,948.83) and 8000.25 (interquartile range: 1819.93-11,359.55) µg/L. The highest quartile of baseline DEHP was associated with 1.11 fold risk of carcinoma in situ (95 % CI, 1.00, 1.23, p < 0.001) and 1.27 fold risk of benign neoplasm (95 % CI, 1.05, 1.54, p < 0.001). As for yearly-average exposure, each quartile of DEHP was positively associated with higher risk of malignant neoplasm (HR, 1.05; 95 % CI, 1.03, 1.07, p < 0.001), carcinoma in situ (HR, 1.08; 95 % CI, 1.04, 1.11, p < 0.001) and benign neoplasm (HR, 1.13; 95 % CI, 1.07, 1.20, p < 0.001). Stratification analysis showed no significant modification effects on the DEHP-neoplasm relationship by menopausal status or ethnicity but a suggestive higher risk in younger women and those who underwent oral contraceptive pill therapy. In sensitivity analysis, the associations remained when excluding the cases diagnosed within 2 years post baseline. CONCLUSIONS: Real-world level of DEHP exposure was associated with higher risk of breast neoplasms. Because of the health risks associated with DEHP, its release to the environment should be managed.

A Dermoid Cyst of the Head, Neck, and Face Region: A Case Report.

Dermoid cyst (DC), a rare benign tumor of developmental origin that develops from mesoderm and ectoderm, is frequently identified in children. DC refers to three cysts that are histologically related, namely, DC, epidermoid cyst, and teratoma. About 70% of DCs are discovered in children aged five years or younger, with the majority being congenital. DC of the head and neck are rare, accounting for only 7% of all such cysts. DC, or benign cutaneous tumors, tend to grow and persist. The presence of epithelial cells along the lines of embryonic closure results in a DC. It is always difficult to properly diagnose these lesions using clinical tests and conventional radiography. Histologically, a DC must have two germ cell layers, and the diagnosis can only be made with pathologic confirmation. Specialized imaging tests including CT, MRI, ultrasonography, and histological examinations should be performed to make a diagnosis and choose the best course of action for surgery.

Respiratory Epithelial Adenomatoid Hamartoma at an Unusual Location: A Case Report and Literature Review.

Respiratory epithelial adenomatoid hamartoma (REAH) in the head and neck is a rare benign lesion containing glandular tissue covered with ciliated respiratory epithelium. In the head and neck, REAH of the nasal cavity, paranasal sinuses, and nasopharynx have been reported in literature. Due to rareness of REAH and insufficient knowledge of its imaging features, the diagnosis can be challenging when we encounter a non-specific cystic mass at an uncommon site in the head or neck. Here, we report the case of a pathologically confirmed REAH showing a cystic mass centered at the buccal space (retromaxillary fat pad) with CT and MRI findings.

Multimodal Method for Differentiating Various Clinical Forms of Basal Cell Carcinoma and Benign Neoplasms In Vivo.

Correct classification of skin lesions is a key step in skin cancer screening, which requires high accuracy and interpretability. This paper proposes a multimodal method for differentiating various clinical forms of basal cell carcinoma and benign neoplasms that includes machine learning. This study was conducted on 37 neoplasms, including benign neoplasms and five different clinical forms of basal cell carcinoma. The proposed multimodal screening method combines diffuse reflectance spectroscopy, optical coherence tomography and high-frequency ultrasound. Using diffuse reflectance spectroscopy, the coefficients of melanin pigmentation, erythema, hemoglobin content, and the slope coefficient of diffuse reflectance spectroscopy in the wavelength range 650-800 nm were determined. Statistical texture analysis of optical coherence tomography images was used to calculate first- and second-order statistical parameters. The analysis of ultrasound images assessed the shape of the tumor according to parameters such as area, perimeter, roundness and other characteristics. Based on the calculated parameters, a machine learning algorithm was developed to differentiate the various clinical forms of basal cell carcinoma. The proposed algorithm for classifying various forms of basal cell carcinoma and benign neoplasms provided a sensitivity of 70.6 ± 17.3%, specificity of 95.9 ± 2.5%, precision of 72.6 ± 14.2%, F1 score of 71.5 ± 15.6% and mean intersection over union of 57.6 ± 20.1%. Moreover, for differentiating basal cell carcinoma and benign neoplasms without taking into account the clinical form, the method achieved a sensitivity of 89.1 ± 8.0%, specificity of 95.1 ± 0.7%, F1 score of 89.3 ± 3.4% and mean intersection over union of 82.6 ± 10.8%.

Desmoid Fibromatosis of the Anterior Abdominal Wall in Pregnancy: A Case Report and Review of the Literature.

A desmoid tumor (DT) is a rare benign neoplasm arising from muscle aponeurosis, associated mostly with trauma or pregnancy. DT has an infiltrative and locally aggressive growth pattern and usually does not metastasize. However, it has a high recurrence and complication rate. When it occurs in pregnancy, the pregnancy and delivery is taken as an individual case for optimal management by physicians and midwifes, who need to be cautious in finding the optimal delivery mode for the patient, which depends on the tumor size, location, behavior, and past history. The authors report a case of 29-year-old pregnant woman who previously underwent systemic oncological treatment for a large abdominal wall desmoid tumor and became pregnant afterwards. The history of DT presented a follow-up and delivery challenge. Observational management was chosen with an elective cesarean section at week 38 + 4 of pregnancy with uncomplicated postpartum follow-up. The authors detail the clinical management and chosen therapeutic approach; chemotherapy can be a choice in the treatment options for patients with DTs, although the majority of DTs are treated surgically with subsequent mesh plastic. Moreover, the authors provide a systematic review of the literature focused on the treatment management of DTs in pregnant women during pregnancy and the postpartum period, as pregnancy-associated desmoid tumors are a specific condition, where the optimal management is not well established, despite some guidelines for non-pregnant patients.

Diffuse intestinal ganglioneuromatosis. A post mortem diagnosed challenging case

Intestinal ganglioneuromatosis (GN) is a benign disease of the autonomic nervous system characterized by hyperplasia of intramural plexuses of the gastrointestinal tract and enteric nerve fibers. Next, we expose an intestinal ganglioneuromatosis case that was difficult to diagnose despite an exhaustive evaluation, for further understanding of the disease. (AU)

Enlarging pulmonary cyst: a rare form of alveolar adenoma.

BACKGROUND: Alveolar adenoma is a rare benign tumour, usually presenting as a peripherally located solid mass, sometimes mimicking malignancy. CASE PRESENTATION: A 37-year-old woman presented with chronic intermittent vague chest discomfort. The chest x-ray showed a simple cyst in the left lower lung field, and serial computed tomography (CT) over the following 2-year period showed rapid growth of the cyst, from 3.5 to 9.0 cm in diameter. The CT scan suggested bronchiolar communication, which was suspected to be the cause of growth, via check-valve mechanism. Thoracoscopic surgery was performed, and we found a thin-walled cyst in the lingular segment. Wedge resection was performed and the pathology was an unexpected alveolar adenoma which had grown on the terminal bronchiole, causing the alveolus to rupture and the cyst to grow. In 48 months of follow-up, there was no evidence of recurrence and the patient's symptoms resolved. CONCLUSIONS: Rapidly growing pulmonary cysts can lead to complications including rupture with pneumothorax and haemothorax, and surgery is always indicated. Abnormally rapid growth may indicate an underlying pathology such as alveolar adenoma. Surgical resection is the treatment of choice and there have been no reported cases of recurrence. Here we present a rare form of alveolar adenoma, which was a form of rapidly growing pulmonary cyst.

Phyllodes Tumor of the Breast Complicated With Mastitis.

One of the rarest fibro-epithelial neoplasms of the breast during pregnancy is the phyllodes tumor (PT). It is typically a painless, bi-phasic, and rapidly growing neoplasm that resembles fibroadenomas. It is still unclear if the neoplasm is hormone-dependent during pregnancy. It is often challenging to diagnose and treat PT. Herein, we report a case of a 30-year-old female at 31 weeks gestation who was diagnosed with a benign phyllodes tumor of her breast with concurrent mastitis. She was first seen during her third trimester where the neoplasm was around 5 cm as reported by the ultrasound (US) examination. Her biopsy report was suggestive of a PT and she was advised surgery with excision of the tumor margin, but she refused. Ten days after her delivery she presented to the emergency department with a fever and a hard, engorged, erythematous, and tender left breast. She was diagnosed with mastitis of the left breast. She then underwent incision and drainage of the left breast that drained purulent milk; additionally, large necrotic grape-like tissues were removed and were confirmed by the histopathology report as a benign phyllodes tumor of the breast.

A rare benign tumor of the liver mimicking angiosarcoma: Anastomosing hemangioma.

Anastomosing hemangioma of the liver (AHL) is a very rare condition and limited to a few cases. It is often confused with well-differentiated angiosarcomas and causes overtreatment. In this report, we present a 53-year-old female patient diagnosed with AHL. Since the tumor is rarely seen, it is important to define well the imaging and pathological features for preventing unnecessary surgeries and related morbidities.

Manejo cirúrgico da hiperplasia fibrosa: relato de caso / Surgical management of fibrous hyperplasia: case report / Tratamiento quirúrgico de la hiperplasia fibrosa: informe de um caso

Objetivo: Relatar um caso de hiperplasia fibrosa inflamatória em lábio inferior, decorrente de um transtorno de comportamento repetitivo (mordedura) e o seu devido tratamento. Relato de caso: Paciente do gênero masculino, 27 anos de idade, apresentou aumento de volume em região de lábio inferior, indolor, com evolução clínica de seis a sete meses, com relatos de práticas de mordedura em região de lábio inferior. Ao exame clínico observou-se lesão exofítica em coloração de mucosa, pediculada, medindo cerca de 8mm, no seu maior diâmetro, com aspecto circunferencial, consistente à palpação e não sangrante. O paciente foi submetido à biópsia excisional, mantendo-se uma distância mínima de 5mm do pedículo. Conclusão: No caso relato, o paciente foi submetido a uma biópsia excisional com a completa remoção da lesão e obteve um prognóstico favorável... (AU)

Objective: To report a case of inflammatory fibrous hyperplasia in the lower lip, resulting from a repetitive be havior disorder (biting) and its proper treatment. Case report: Male patient, 27 year sold, presented pain less swelling in the lowerl ipregion, with clinical evolution of sixt o seven months, with report sof biting practices in the lower lip region. Clinical examination revealed an exophytic lesion in mucosal color, peduncula ted, mea suring about 8 mm in its largest diameter, with a circumferent ial appearance, consisten ton palpation and not bleeding. The patient underwent excisional biopsy, keeping a minimum distance of 5 mm from the pedicle. Conclusion: In the case report, the patient underwent a nexcision al biopsy with the complete removal of the lesion and obtained a favorable prognosis... (AU)

Objetivo: Informar de un caso de hiperplasia fibrosa inflamatoria del labio inferior debido a um trastorno de comportamiento repetitivo (morder) y su tratamiento. Reporte de caso: Paciente masculino, de 27 años, presentó un aumento de volumen em la región del labio inferior, indoloro, com evolución clínica de seis a siete meses, con reporte de prácticas de mordedura em la región del labio inferior. El examen clínico reveló una lesión exofítica, pedunculada, de coloración mucosa, que medía aproximadamente 8mm em su mayor diámetro, de aspecto circunferencial, consistente a la palpación y no sangrante. El paciente fue sometido a una biopsia excisional, manteniendo una distancia mínima de 5mm del pedículo. Conclusión: Em el caso relatado, el paciente fue sometido a una biopsia excisional com la remoción completa de lalesión y obtuvo um pronóstico favorable... (AU)

Basaloid follicular hamartoma syndrome: acquired sporadic variant with hypothyroidism, hypohidrosis and alopecia, a rare case.

Basaloid follicular hamartoma is a rare benign malformation of hair follicles, characterised clinically as generalised or localised multiple brown papules mostly on face, scalp and trunk. It may be congenital or acquired with or without any associated disease. Histologically it is composed of epithelial proliferation of basaloid cells with radial disposition enclosed in a fibrous stroma. It is of important consideration because it can be mistaken for basal cell carcinoma both clinically and histologically. Here we report the case of a 51-year-old female with acquired, generalised basaloid follicular hamartomas associated with alopecia, hypothyroidism and hypohidrosis which is an extremely rare disease.

Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations.

(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.

Lipoleiomyoma With Bizarre Nuclei and Abundant Mast Cells.

Lipoleiomyoma is an uncommon neoplasm of the uterus with a variable incidence in the literature. Histologically, it consists of smooth muscle cells intermixed with mature adipocytes. The histogenesis of this tumor remains obscure and the presence of atypical cells may raise the suspicion of leiomyosarcoma so it is crucial to distinguish between the two. On the other hand, tumor-associated mast cells are being recognized as tumor modulators and potential therapeutic targets. Here, we discuss the case of a 57-year-old female, who presented with a nonspecific symptom of postmenopausal bleeding. She was found to have a large uterine mass and had been treated surgically with a hysterectomy. Histological examination revealed the diagnosis of this uncommon entity. Considering the rarity of the disease, we report this case to add to the existing literature. Furthermore, the significance of these findings is still poorly understood and needs more investigation to fill in the lacking knowledge.