Benign tumors of the pediatric spine: statistical notes

Consensus exists that a do-not-attempt-resuscitation order (DNAR) is appropriate if a resuscitation attempt is futile. Less agreement exists when this point is reached. We investigated the influence of three major considerations for in-hospital DNAR orders: expected survival probability after resuscitation, prospects of the patients' current condition without a cardiac arrest and the patients' autonomous decision not to want resuscitation. We calculated an expected survival probability according to two multi-morbidity prediction scores for each patient, assuming the event of cardiac arrest. The prospects of the current condition without a cardiac arrest was estimated by the patients' physician, in terms of life expectancy and quality of life (level of dependency after discharge and pain). The patients' preference was documented from the medical records. A total of 470 patients were included in the study. Fifty-eight patients (12%) had a DNAR-order, 11 of these patients (19%) wanted no resuscitation. The patients' prospects (life expectancy, dependency after discharge), and age proved to be independently associated with the presence of a DNAR order. The odds ratio (OR) for the presence of a DNAR order was 37 (CL 14-107) for an estimated life expectancy less than 3 months, 13 (CL 4-41) for a life in a nursing home and four (CL 2-12) for an age of 80 years and older. Expected survival probability after resuscitation and pain were not independently associated with a DNAR order. We conclude that resuscitation is considered futile on the basis of the patients' age and prospects without cardiac arrest and that the impact of expected survival probability on these decisions is small.     

Benign testicular and paratesticular tumors

Eighty-three patients with Sjogren's disease, 23 with chronic parotitis and periodontitis, 325 controls were examined by general clinical, dental, X-ray, microbiological, immunological, and morphological methods. A clinico-pathogenetic analysis of dental manifestations of Sjogren's disease was carried out: atrophy and inflammatory process in the buccal mucosa, multiple caries. A pathogenetically based program of therapeutic and prophylactic measures making use of encad, bensilol, bensilol+trimecain is suggested for patients with Sjogren's disease.     

Benign bone and soft-tissue tumors about the knee

In the xenotransplantation research field, pig aortic endothelial cells are frequently used in different model systems, e.g., for the study of the xenoantibody-antigen reaction. The Gal(alpha1),3Gal determinant is the major target for human xenoreactive antibodies in pig tissue. Characterisation of the Gal(alpha1)- distribution in pig aortic endothelial cells is thus important for understanding the reaction occurring at the endothelial cells during the xenorejection. We have determined the complete structure of the major Gal(alpha1),3Gal terminated glycolipid, Gal(alpha1),3nLc4Cer. Structural studies were performed on isolated glycosphingolipids by mass spectrometry and NMR spectroscopy. The results show a predominance of the pentasaccharide among the Gal(alpha1)-terminated glycolipids but also the presence of several Gal(alpha1)-terminated glycolipids with extended carbohydrate core chains. Ultrastructural localisation of the Galalpha1-antigen in pig aorta was done by lectin-gold electron microscopic studies of aortic wall sections using the Griffonia simplicifolia isolectin B4. Gal(alpha1)-determinants are predominantly localised on the luminal surface of pig aortic endothelial cells and endothelial cells of vasa vasorum and, to a lesser extent, vascular subendothelium.     

Benign solid and papillary epithelial tumors of the pancreas

The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.     

Benign hepatocellular tumors: MRI after superparamagnetic iron oxide administration

OBJECTIVE: Our goal was to describe the features of benign hepatocellular tumors on superparamagnetic iron oxide (SPIO)-enhanced MR images and to evaluate the potential role of SPIO administration in the diagnosis of these tumors. MATERIALS AND METHODS: The T1- and T2-weighted SE images were performed before and after SPIO administration in 19 patients with focal nodular hyperplasia (FNH) or adenomas. The lesions were counted and qualitatively assessed. In 32 tumors with a diameter of > 10 mm, the contrast-to-noise ratio (CNR) and the liver and tumor enhancement were calculated. RESULTS: Thirty-seven tumors were detected on MR images: 29 before and 36 after SPIO administration (p < 0.05). The SPIO-enhanced T1-weighted images provided the highest detection rate and CNR. The central scar was most conspicuous on SPIO-enhanced T2-weighted images. Most FNHs and adenomas lost less signal than the liver, three tumors did not lose signal, and four FNHs showed a signal loss equal to or greater than that of the liver. CONCLUSION: The SPIO-enhanced T1-weighted images increased the CNR and the detection rate of benign hepatocellular tumors. On T2-weighted images, most benign hepatocellular tumors showed a signal decrease after SPIO administration. No significant difference in signal loss was observed between FNH and adenomas.     

Pediatric liver tumors

The information in this chapter is a resource for the pathologist faced with a pediatric liver tumor. Each tumor is characterized concisely and appropriate references are provided for more detailed study. Examples of tumors are presented from the files of Children's Hospital-Oakland and from the University of California Medical Center.     

Pediatric liver tumors

An infant or child who presents with a large intrahepatic mass will most likely have a malignant tumor. In children, benign tumors constitute only 30% of liver tumors and most are vascular in origin. Treatment of benign vascular tumors is conservative and seldom surgical. Hepatoblastoma is the most common malignant tumor followed by hepatocellular carcinoma. Treatment of malignant tumors is based on a combination of surgery and chemotherapy. Children with hepatic malignancies that can be resected have an excellent prognosis. Other rare benign and malignant tumors of the liver do occur and surgery plays a critical role in management.     

Regional chemotherapy of liver tumors

In the absence of adequate autogenous vein for tibial artery bypass in limb salvage surgery, the use of prosthetic grafts with a distal anastomotic vein cuff or patch has shown promising results. Here, we describe how the Florester Internal Vessel Occluder (Meadox UK, Bedfordshire, UK) can facilitate the construction of a distal anastomotic vein cuff.     

Benign schwannoma of the liver with cystic changes misinterpreted as hydatid disease

The rare event of a benign mesenchymal tumor of the liver is described since its cystic transformation resembled hydatid disease through the presence of Echinococcus. Ultrasound and computerized tomography showed a cystic mass within the liver of a 57 year-old woman with upper abdominal pain. This was interpreted as hydatid disease and an evacuation procedure was performed. The histopathology of a minute specimen was interpreted as consistent with chronic inflammation in a cyst wall. Five years later, a recurrence of the parasite was suspected, and complete excision of the mass and resection of a bile fistula was performed. The histopathological examination revealed a large benign schwannoma with regressive cystic changes, proven by positive immunoreaction for the neurogenic marker S-100 protein. Revision of old paraffin blocks of tissue taken during the first operation was able to retrospectively confirm the identical tumor by the same markers. Occurrence of schwannomas in parenchymatous organs or the retroperitoneum is extremely rare and may lead to asymptomatic growth with cystic changes, causing considerable difficulties in imaging procedures. Overall, the primary complete excision of cystic masses within the liver seems to be the best approach in discovering their real nature and to ultimately cure them.     

Benign fibromatous tumors of the testis and paratesticular region: a report of 9 cases with a proposed classification of fibromatous tumors and tumor-like lesions

Benign intrascrotal fibrous proliferations are uncommon, with most arising from the paratesticular region and falling into the category of so-called fibrous pseudotumor. We describe two neoplastic forms of benign fibrous tumor of the testis and its adnexa: fibroma of gonadal stromal origin and fibroma of the testicular tunics. Three patients with gonadal stromal fibroma were 28, 33, and 35 years of age and presented with painless masses. The tumors were circumscribed, intratesticular, yellow-white or white lesions 0.9 to 4.0 cm in diameter and had microscopic features identical to those of the ovarian fibroma. Immunohistochemically, the tumor cells were strongly positive for vimentin (3/3 cases), focally positive for actin and desmin (2/3 cases) and negative for S-100, keratin, and CD34 (3/3 cases). Six fibromas of the testicular tunics arose in patients 22, 34, 60, 68, 70, and 74 years old and were also asymptomatic masses. Four of them were circumscribed, whorled, white masses arising from the tunica albuginea with variable areas of myxoid change; one was pedunculated and grew exclusively into the cavity of the tunica vaginalis, whereas the other three at least partially extended into the testis as well. The other two tumors were unattached to the tunica albuginea and presented as circumscribed, white-tan paratesticular masses, partially covered by tunica vaginalis. Microscopically, the tumors were slightly to moderately cellular, with bland spindle or stellate cells lying in a myxoid or collagenous stroma with prominent vessels. The two paratesticular tumors had features typical of solitary fibrous tumor. Immunohistochemically, the fibromas of the testicular tunics were negative for S-100, keratin, and desmin. Focal, weak reactivity for actin was present in one case. CD34 was positive in three cases; in the two tumors resembling solitary fibrous tumors it was strong, and in the other it was focal and was limited to the region just below the tunica vaginalis. Eight tumors were treated by radical orchiectomy and one by excision of the mass alone. The outcome was benign in the seven cases in which followup information is available.