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1.
World Neurosurg ; 133: e241-e251, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505289

RESUMO

BACKGROUND: Cystic sellar masses (CSMs) pose diagnostic and therapeutic challenges associated with subtotal cyst wall resection, cerebrospinal fluid (CSF) leak repair, and disease recurrence. Current magnetic resonance imaging (MRI) interpretation often cannot reliably differentiate CSMs, mandating adaptable intraoperative strategies. We reviewed our diagnostic and therapeutic experience after endoscopic endonasal approaches (EEAs) for CSMs. METHODS: A retrospective record review of patients with CSM managed via EEA at the University of Southern California from 2011 to 2018 was conducted. Patient demographics, preoperative characteristics, surgical details, pathologic findings, and postoperative outcomes were assessed. RESULTS: Analysis included 47 patients (mean age, 43.2 years); of these, 78.7% were women. Preoperative symptoms included headache (76.6%) and vision loss (42.6%). Histologically verified sellar pathology included 27 Rathke cleft cysts (RCCs) (57.4%), 17 cystic pituitary adenomas (CPAs) (36.2%), 2 arachnoid cysts (4.3%), and 1 xanthogranuloma (2.1%). Twelve patients (70.6%) with CPAs underwent complete resection and 5 (29.4%) underwent subtotal resection. All 27 patients with RCC and 2 patients with arachnoid cyst underwent complete fenestration and drainage. One xanthogranuloma was completely resected. There were 14 intraoperative (29.8%) and 4 postoperative CSF leaks (8.5%). Headaches, vision, and endocrinopathy improved in 69.2%, 80.0%, and 33.3% of patients with CPA and 73.9%, 71.4%, and 40.9% of patients with RCC, respectively. There were 2 RCC recurrences and 1 CPA recurrence over the follow-up period. CONCLUSIONS: Surgeons must prepare for versatile management strategies of CSMs based on pretest probability associated with MRI and intraoperative findings. Outcomes after EEA for CSMs show low complication profiles and excellent rates of headache and visual improvement, albeit lower rates of endocrine normalization.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroimagem/métodos , Sela Túrcica , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Hipopituitarismo/etiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/cirurgia , Transtornos da Visão/etiologia , Xantomatose/complicações , Xantomatose/diagnóstico , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
3.
BMJ Case Rep ; 12(7)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31337625

RESUMO

We present the case of a 34-year-old woman who was diagnosed to have adenocarcinoma of the caecum based on the clinical, radiological, histopathological and intraoperative findings. However, postoperative histopathology showed only features of xanthogranulomatous inflammation without any evidence of malignancy. This benign chronic inflammatory condition could present as a histological surprise. It is important for both surgeons and pathologists alike to be aware of this.


Assuntos
Adenocarcinoma/patologia , Colo Ascendente/patologia , Doenças do Colo/patologia , Neoplasias do Colo/patologia , Erros de Diagnóstico , Granuloma/patologia , Inflamação/patologia , Xantomatose/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adulto , Biópsia , Colectomia , Doenças do Colo/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Feminino , Granuloma/diagnóstico , Humanos , Inflamação/diagnóstico , Xantomatose/diagnóstico
4.
BMJ Case Rep ; 12(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31266759

RESUMO

A case of multiple xanthogranulomas located bilaterally on arms, armpits, legs, trunk, abdomen, scalp, neck and plantar surfaces in a 25-year-old man is reported. The patient was evaluated by polarised light dermoscopy and reflectance confocal microscopy (RCM) that showed peculiar aspects. In particular, dermoscopy showed a homogeneous orange-yellowish hue that is related to the histopathological presence of foamy histiocytes and Touton giant cells; the last typically appeared at RCM as peculiar giant cells surrounded by highly refractive ring due to the cytoplasm rich of lipids. Laboratory investigations, including routine haematological examination, liver and renal function tests, serum lipid and sugar levels were normal. The patient started isotretinoin 20 mg once daily. After 6 months, some lesions flattened, leading to yellowish or hyperpigmented macules, but new lesions raised up.


Assuntos
Dermoscopia/métodos , Neoplasias Cutâneas/diagnóstico , Xantomatose/diagnóstico , Adulto , Fármacos Dermatológicos/uso terapêutico , Diagnóstico Diferencial , Humanos , Isotretinoína/uso terapêutico , Masculino , Microscopia Confocal , Neoplasias Cutâneas/tratamento farmacológico , Xantomatose/tratamento farmacológico
5.
J Oral Pathol Med ; 48(10): 935-942, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31355943

RESUMO

BACKGROUND: The aim of the present study was to report the clinicopathologic, radiographic and immunohistochemical features of five South American cases of intraosseous xanthomas of the mandible and to compare them to those detected in a literature review. METHODS: Clinical data were collected from the records of three Oral and Maxillofacial Pathology services in South America and compared with those compiled from a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus). All cases were evaluated by haematoxylin and eosin staining and immunohistochemistry for CD68 and S-100. RESULTS: The series comprised four females (80%) and one male (20%) with a mean age of 23.3 ± 10.9 years (range: 13-45 years). In four cases, there was involvement of the posterior region of the mandible (80%). The lesions presented radiographically as unilocular (60%) radiolucencies with punched-out margin (80%). All cases predominantly consisted of CD68-positive and S-100-negative xanthomatous cells. No recurrences were observed after curettage, with a median follow-up of 27 months. CONCLUSION: Intraosseous xanthoma of the jaws is a rare benign disorder. We report here five additional cases affecting the mandible, for a total of 36 cases of the jaws reported in the literature. Overall, this lesion has predilection for posterior sites of the mandible of asymptomatic young adults.


Assuntos
Neoplasias Ósseas/diagnóstico , Mandíbula/patologia , Xantomatose/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Diagn Cytopathol ; 47(9): 939-942, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31169968

RESUMO

Xanthomas are papulonodular skin lesions present in lipoprotein metabolism disorders, which result in cholesterol deposits in subcutaneous tissue, tendons, ligaments, periosteum, etc. A 11-year-old male presented with multiple soft tissue swellings, prominently over joints. Fine-needle aspiration (FNA) from multiple sites had similar appearance with foamy histocytes and giant cells. Oil Red O and polarized microscopy were also positive for fat. We describe an unusual case of tendinous and tuberous xanthoma diagnosed by cytology. Acquaintance with fine-needle aspiration cytology findings in xanthomas can help to avoid the need of surgical biopsy, as xanthomas can regress on medical therapy alone.


Assuntos
Neoplasias Cutâneas , Xantomatose , Biópsia por Agulha Fina , Criança , Humanos , Masculino , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Xantomatose/diagnóstico , Xantomatose/metabolismo , Xantomatose/patologia
8.
Hautarzt ; 70(6): 438-442, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31076815

RESUMO

Cutaneous xanthomas may develop in patients with lipid abnormalities, chronic inflammatory diseases or cancer. Especially myeloproliferative diseases may be accompanied by dystrophic xanthomas. We report on a normolipemic patient with cutaneous xanthomas who was subsequently diagnosed with mycosis fungoides. In addition to illustrative clinical and histopathological images, we present an overview of reports on dystrophic xanthomas in mycosis fungoides, the most frequent cutaneous T­cell lymphoma.


Assuntos
Linfoma Cutâneo de Células T , Micose Fungoide/diagnóstico , Xantomatose/diagnóstico , Humanos , Neoplasias Cutâneas
10.
Zhonghua Yan Ke Za Zhi ; 55(5): 381-386, 2019 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-31137151

RESUMO

Objective: To investigate the clinical, imaging and pathological features of adult onset xanthogranuloma. Methods: Retrospective case series study.The clinical data of 4 adult patients with adult onset xanthogranuloma treated in the Tianjin Medical University Eye Hospital from 2015 to 2017 were analyzed. Results: There were 1 male and 3 females, aged 46-73 years, with an average age of 55 years. The duration of eyelid swelling was from 6 months to 6 years. One case was binocular and 3 cases were monocular. There were progressive enlargement of eyelid swelling and subcutaneous cord nodules with poor mobility and no tenderness in all 5 eyes. The eyelid skin in 2 patients (2 eyes) was bulging and yellow. CT examination showed swelling of the eyelids and soft tissue thickening in 5 eyes. There were lacrimal gland enlargement in 3 eyes, upper rectus muscle involvement in 3 eyes, external rectus muscle involvement in 1 eye, lower rectus muscle involvement in 1 eye, superior oblique muscle involvement in 1 eye, and involvement of both the superior and inferior rectus muscles in 1 eye. In 1 patient (1 eye), the lesion showed low and medium signals on T(1) weighted images and T(2) weighted images. Three patients (4 eyes) underwent color Doppler ultrasonography, showing the echo zone in the irregularly shaped eyelid was strong, the internal echo was uneven, the local echo was low, and the boundary was not clear. One of the eyes showed a blood flow signal. All patients underwent surgical resection. The pathological results showed infiltration of foamy tissue cells, Touton cells, lymphocytes and plasma cells. Immunohistochemistry demonstrated 3 patients (4 eyes) expressed CD68, and 1 patient (1 eye) expressed S-100. After 6 months to 2 years of follow-up, 3 patients had no recurrence. One patient developed eye discomfort at 6 months after surgery, and the symptoms were relieved after treatment with triamcinolone. Conclusions: Adult onset xanthogranuloma mainly manifest as eyelid swelling, periorbital mass and skin color changes, generally with no systemic involvement. Imaging examination mainly shows the involvement of soft tissues, lacrimal glands and muscles around the eyelids. The main features of the pathology are infiltration of foamy tissue cells, Touton giant cells, lymphocytes and plasma cells. (Chin J Ophthalmol, 2019, 55: 381-386).


Assuntos
Pálpebras/diagnóstico por imagem , Aparelho Lacrimal/diagnóstico por imagem , Doenças Orbitárias/diagnóstico , Ultrassonografia Doppler em Cores , Xantomatose/diagnóstico , Adulto , Idade de Início , Idoso , Feminino , Granuloma , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Arch. Soc. Esp. Oftalmol ; 94(5): 248-251, mayo 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-180831

RESUMO

El xantogranuloma orbitario del adulto es un raro trastorno inflamatorio idiopático incluido dentro de las enfermedades xantogranulomatosas orbitarias, con posible asociación a otras condiciones sistémicas. Presentamos el caso de una mujer de 43 años que presentó una masa profunda de crecimiento rápido en el párpado superior derecho con antecedentes de nódulos amarillentos no ulcerativos en el párpado superior, bilaterales, y 2 blefaroplastias superiores previas. Se realizó biopsia-extirpación de la lesión orbitaria anterior, siendo los hallazgos anatomopatológicos compatibles con xantogranuloma histiocítico del adulto. El estudio sistémico fue negativo y la paciente se encuentra asintomática sin tratamiento. Las enfermedades xantogranulomatosas orbitarias constituyen una entidad rara potencialmente grave, por lo que el oftalmólogo debe de estar familiarizado con esta enfermedad para poder realizar un diagnóstico precoz a través de la anamnesis, exploración y la histología de lesiones que en ocasiones pueden simular xantelasmas palpebrales


Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas


Assuntos
Humanos , Feminino , Adulto , Doenças Orbitárias/diagnóstico , Xantomatose/diagnóstico
13.
Gastrointest Endosc ; 90(3): 440-447.e1, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31034809

RESUMO

BACKGROUND AND AIMS: An e-learning system teaching endoscopic diagnostic process for early gastric cancer using magnifying endoscopy with narrow-band imaging (M-NBI) was established, and its efficacy in improving the diagnostic performance for early gastric cancer was proven in a multicenter randomized controlled trial. The aim of this study was to clarify the difference in learning effect in each lesion characteristic. METHODS: Three hundred sixty-five participants diagnosed 40 gastric lesions based on M-NBI findings using the vessel-plus-surface classification system. The diagnosis data collected from each participant were assessed in this study. The accuracy of NBI cancer diagnosis was assessed using area under the receiver operating characteristics curve (AUC/ROC) analysis. AUC/ROCs were separately calculated in each lesion characteristic (shape and size), and the data were compared between tests 1 and 3. RESULTS: Continuous net reclassification improvement (cNRI) analysis of all lesions revealed significant improvement in reclassification when participants underwent e-learning (cNRI, 1.17; P < .01). The integrated discrimination improvement analysis demonstrated that the e-learning system improved diagnostic ability (.19; P < .01). According to the analysis depending on the lesion's characteristics, high AUC/ROCs were demonstrated in depressed and small lesions (<10 mm; .90 and .93, respectively). The cNRI analysis showed remarkable e-learning improvement in both depressed (cNRI, 1.33; P < .01) and small lesions (cNRI, 1.46; P < .01). However, no significant e-learning improvement was observed in elevated or flat lesions. CONCLUSIONS: In M-NBI education for endoscopists, a good learning outcome was obtained in depressed and small lesions, but a poor learning outcome was demonstrated in elevated and flat lesions. (Clinical trial registration number: UMIN000008569.).


Assuntos
Adenocarcinoma/diagnóstico , Competência Clínica , Instrução por Computador/métodos , Gastroenterologistas/educação , Gastroscopia/educação , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/patologia , Adenoma/diagnóstico , Adenoma/patologia , Área Sob a Curva , Detecção Precoce de Câncer , Gastrite/diagnóstico , Gastrite/patologia , Gastroscopia/métodos , Humanos , Imagem de Banda Estreita/métodos , Curva ROC , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/patologia , Xantomatose/diagnóstico , Xantomatose/patologia
14.
Medicine (Baltimore) ; 98(16): e14718, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008920

RESUMO

Xanthogranuloma of choroid plexus is an extremely rare, benign, and mostly asymptomatic intracranial lesion. We report a case of symptomatic lateral ventricular xanthogranuloma resected via a neuronavigator-guided ventriculoscopic approach. Then we review recent English medical literature and notice that craniotomies have been the most popular treatment. But our choice of a ventriculoscopic approach possesses unique advantages such as minimized neural tissue damage, shortened operative time, less blood loss, and safer access to central structures over conventional open surgeries. Informed consent has been obtained from the patient and his immediate family regarding this case report.


Assuntos
Encefalopatias/diagnóstico , Plexo Corióideo , Granuloma/diagnóstico , Ventrículos Laterais , Xantomatose/diagnóstico , Adulto , Encefalopatias/complicações , Encefalopatias/diagnóstico por imagem , Encefalopatias/cirurgia , Granuloma/complicações , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroendoscopia , Exame Neurológico , Neuronavegação , Xantomatose/complicações , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
16.
Int J Surg Pathol ; 27(5): 492-498, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30727785

RESUMO

In this series, there are 8 typical verruciform xanthomas of the oral mucosa and 3 anomalies, 1 polypoid, 1 florid, and 1 carcinomatous. All were characterized by infiltrates of CD68-positive xanthomatous histiocytes in the lamina propria. The 11 patients comprised 6 men and 5 women (mean age = 54.5 years, range = 40-69). Both keratinized and nonkeratinized sites were affected. A history of lichenoid inflammation was recorded in 5 patients. The polypoid xanthoma presented in a woman aged 54 years as a polyp of the labial commissure. The florid lesion affected the dorsum of the tongue of a man aged 54 years and at 20 mm was the largest of the 11 lesions, but the only one with candidal infection. The squamous cell carcinoma manifested as a papilloverrucous hyperkeratosis of the palatal gingiva in a man aged 69 years. The latter 2 (and 1 "typical" verruciform xanthoma) required re-excision, but none has since recurred.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Pólipos/diagnóstico , Xantomatose/diagnóstico , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Feminino , Histiócitos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/citologia , Neoplasias Bucais/patologia , Pólipos/patologia , Xantomatose/patologia
18.
J Pak Med Assoc ; 69(2): 256-260, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30804596

RESUMO

Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis, which can involve adjacent organs including liver, colon and duodenum mimicking gallbladder cancer. Preoperative and intraoperative differentiation of xanthogranulomatous cholecystitis from gallbladder cancer is often difficult and the final diagnosis is made on histopathology of the resected specimen. We hereby report four cases of xanthogranulomatous chol ec ystitis w hich were misdiagnosed as cases of advanced gallbladder cancer based on presentation and radiological findings and underwent radical resections but the final histopathology was a diagnostic surprise. Xanthogranulomatous cholecystitis is still a diagnostic challenge as no single modality has been helpful to diagnose this entity till date. Radical resection seems justified in patients who present with the features mimicking gallbladder cancer.


Assuntos
Colecistectomia/métodos , Colecistite , Erros de Diagnóstico/prevenção & controle , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar , Hepatectomia/métodos , Xantomatose , Adulto , Idoso , Biópsia/métodos , Colecistite/diagnóstico , Colecistite/patologia , Colecistite/fisiopatologia , Colecistite/cirurgia , Diagnóstico Diferencial , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Humanos , Fígado/patologia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Desnecessários , Xantomatose/diagnóstico , Xantomatose/patologia , Xantomatose/fisiopatologia , Xantomatose/cirurgia
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