17 June 2021: Textbook Updates

We have posted updates of the followingtopics:

Appendix > Other tumors > Well differentiated neuroendocrine tumor
by Chien-Kuang Cornelia Ding, M.D., Ph.D., Kwun Wah Wen, M.D., Ph.D.
Topic summary: Well differentiated appendiceal epithelial neoplasms that likely arise from neuroendocrine cells, including enterochromaffin (EC) cell neuroendocrine tumors (NETs), L cell NETs and tubular NETs. Most commonly seen at the tip of the appendix (67% of adult patients, 73% of pediatric patients). Incidence of 0.15 – 0.6 cases per 100,000 person years; slight female predominance and highest incidence before the age of 40 years. Predominantly diagnosed incidentally with other diseases, such as acute appendicitis. Size of the primary tumor is the most reliable indicator of distant metastases (30% in tumors ≥ 2 cm). Simple appendectomy is considered curative for tumor < 1 cm.

Liver & intrahepatic bile ducts > General > Cirrhosis
by Anthony W.H. Chan, M.B.Ch.B.
Topic summary: Diffuse nodulation of liver due to fibrous bands subdividing liver into regenerative nodules. Viral hepatitis B / C, alcoholic liver disease, nonalcoholic (metabolic associated) fatty liver disease are most common causes. Major cause of global health burden, accounting for 1.2% of disability adjusted life years (DALYs) and 2% of deaths worldwide in 2010. General (nonspecific) clinical features: malaise, fatigue, anorexia, weight loss. Diagnosis: ultrasound, CT or MRI radiologically. There are multiple nodular isodense lesions deforming the liver margin on the arterial phase CT. Treatment: treating the underlying cause of cirrhosis, treating and preventing complications, avoiding additional liver injury (e.g. alcohol); patients with MELD ≥ 15 or decompensation should be referred to a transplant center.

Oral cavity & oropharynx > Congenital anomalies > Lingual tonsil
by Molly Housley Smith, D.M.D.
Topic summary: Collection of reactive submucosal lymphoid nodules situated on the dorsal or lateral aspects of the tongue base, which presents clinically as red papules or nodules. Often clinically diagnostic, although asymmetric, hyperplastic nodules may warrant biopsy to rule out lymphoma or other pathology. Associated with obesity, obstructive sleep apnea, laryngopharyngeal reflux, younger age, allergic rhinitis and smoking. Diagnosis is made upon clinical features or awake endoscopy. Head and neck computed tomography (CT), magnetic resonance imaging (MRI) and skull lateral radiographs demonstrate lingual tonsils at the level of the epiglottis on the tongue base. Nonsurgical medical management or surgical debulking / removal may be indicated in cases of hyperplastic lingual tonsil contributing to sleep apnea.

Ovary > Other nonneoplastic > Corpus luteum cyst
by Aurelia Busca, M.D., Ph.D., Carlos Parra-Herran, M.D.
Topic summary: Ovarian cyst > 3 cm in diameter, lined by luteinized granulosa and theca cells. Functional cysts in women of reproductive age, including pregnancy. Corpus luteum is a physiological postovulatory structure formed after the dominant follicle releases the ovum; cystic dilation happens when corpus luteum fails to regress and becomes enlarged with fluid / blood. Patients can be asymptomatic or present with menstrual irregularities, amenorrhea, abdominal pain, palpable abdominal mass if large size. On pelvic ultrasound, appears as simple ovarian cyst, often hemorrhagic; incidental finding or diagnosed during symptomatic workup. Most cysts resolve spontaneously. Resection if symptomatic, rupture or suspicion for neoplastic process.

Stains & CD markers > WT1
by Urooba Nadeem, M.D., Aliya N. Husain, M.D.
Topic summary: WT1 gene encodes for Wilms tumor protein located on chromosome 11p13. Interpretation is based on staining pattern and antibody used. Transcription factor essential for normal development of the urogenital system. WT1 mutations in Denys-Drash syndrome, diffuse mesangial sclerosis kidney, Fraiser syndrome, Wilms tumor in 15% of cases, congenital nephrotic syndrome, cytogenetically normal acute myeloid leukemia and prostate cancer. Can be exclusively nuclear or cytoplasmic according to the antibodies used (anti-C or N terminus WT1 antibody).

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