12 September 2022: Textbook Updates

We have posted updates of the following topics:

Appendix > Benign tumors > Hyperplastic polyp
by Giby V. George, M.B.B.S., Aaron R. Huber, D.O.
Topic summary: Appendiceal hyperplastic polyps (HPs) are serrated proliferations in the appendiceal mucosa (similar to colorectal hyperplastic polyps) that are devoid of architectural and cytologic dysplasia. Frequently harbor KRAS mutations and are thought to be unrelated to the serrated pathway of colorectal neoplasia. Occurs equally in both men and women; wide age range but mostly in older patients in the sixth to eighth decades of life. Usually incidental finding in appendices removed for other reasons. Benign, not clinically relevant. Appendectomy is curative.

Bone & joints > Other chondrogenic tumors > Synovial & tenosynovial chondromatosis
by Aisha Memon, M.B.B.S., Nasir Ud Din, M.B.B.S.
Topic summary: Synovial chondromatosis is a benign, locally aggressive neoplasm characterized by multiple hyaline cartilaginous nodules involving joint spaces, subsynovial tissue or tenosynovium. Involves large joints, 60 – 70% of cases affecting the knee, followed by hip, shoulder, elbow, ankle and wrist. Rare neoplasm, with an estimated incidence of ~1.8 cases per million person years. Disease recurs in 15 – 20% of cases with higher rates reported in tenosynovial cases; malignant transformation is uncommon and occurs in 5 – 10% of cases. Treatment: arthroscopic or open removal of loose bodies with or without a synovectomy.

Liver & intrahepatic bile ducts > Hepatocellular carcinoma > HCC – lymphocyte rich
by Daffolyn Rachael Fels Elliott, M.D., Ph.D., Ryan M. Gill, M.D., Ph.D.
Topic summary: Rare subtype of hepatocellular carcinoma (HCC) designated by the WHO; characterized by a dense lymphoid infiltrate with more lymphocytes than tumor cells. Very rare tumor with limited clinical and outcome data. Approximately half of cases have underlying cirrhosis or chronic infection with hepatitis B / C. Imaging modalities for diagnosis of HCC: multiphasic computed tomography (CT) or magnetic resonance imaging (MRI). May have better prognosis in comparison to classic HCC; majority of patients present with low stage disease, a single lesion, and without vascular invasion. Treatment: surgical resection; radiofrequency ablation; transarterial chemoembolization (TACE); transplantation (e.g., Milan criteria, modified by some institutions).

Oral cavity & oropharynx > Oral cavity squamous cell carcinoma > SCC-general
by Sarah H. Glass, D.D.S.
Topic summary: Malignant neoplasm that arises from the mucosal epithelium of the oral cavity and shows variable squamous differentiation. Most common cancer of the oral cavity, with a variable clinical appearance and a predilection for the ventrolateral tongue; associated with tobacco, alcohol and betel quid. Globally, highest rates are seen in Melanesia and South Central Asia; it is the leading cause of cancer related death in India for men. Multifactorial with accumulation of genetic alterations; loss of function of TP53 mutations and CDKN2A inactivation are frequently seen. 5 year survival rate of 68.0%. Early staged lesions are often treated with surgery.

Ovary > Other nonneoplastic > Pregnancy luteoma
by Swati Bhardwaj, M.B.B.S., M.D., Tamara Kalir, M.D., Ph.D.
Topic summary: Self limited, hyperplastic (nonneoplastic) proliferation of large, luteinized ovarian cells during pregnancy, resulting in a tumor-like mass of the ovary that regresses spontaneously during puerperium. Microscopic features include diffuse sheets of round cells with abundant eosinophilic cytoplasm and round nuclei. 80% of patients are multiparous; luteomas are rare in primiparous women. Occurs due to nodular hyperplasia of theca interna cells. Usually asymptomatic, with the mass being incidentally detected at cesarean section or tubal ligation at the end of pregnancy. Treatment is usually not necessary as these are spontaneously resolving lesions.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s