scholarly journals Spinal Space Occupying Lesions: A Comprehensive Study of Clinico-pathological Spectrum and Measure of Degree of Agreement Between the Diagnostic Modalities

2020 ◽  
Vol 7 (9) ◽  
pp. A445-458
Author(s):  
Srinivas DD Gubbala ◽  
Sridevi Mattaparti ◽  
Bhavani .
Keyword(s):  
Malignant Tumors ◽  
Indian Subcontinent ◽  
Spinal Tuberculosis ◽  
Lumbar Vertebrae ◽  
Common Finding ◽  
Spinal Tumors ◽  
Kappa Statistics ◽  
Histopathological Diagnosis ◽  
Thoracic Vertebrae ◽  
Spinal Neoplasms

Back ground: Spinal SOLs are quite fascinating group of lesions, comprising a minority of central nervous system lesions often resulting in significant morbidity. There is paucity of comprehensive population-based data of these SOLs in Indian subcontinent.    Material and methods: The present study was a retrospective descriptive study conducted at the department of pathology, Kamineni Institute of Medical Sciences for 3 years starting from January 2017 to December 2019.   Results: We analyzed eighty-nine spinal SOLs during the study period. Spinal neoplasms encompassed the largest number accounting for 70.7% of total spinal SOLs. Majority were reported in the 20-40 years’ age group with predominant male preponderance except for universal phenomenon of female predominance in meningioma. Back pain was the most common clinical presentation. Among spinal neoplasms, NSTs comprising of schwannoma and neurofibroma, was the most common finding and spinal tuberculosis was the most common non-neoplastic SOL. Majority of benign spinal tumors were distributed in the intradural extra medullary location and involved thoracic vertebrae. Malignant tumors predominantly involved extradural location and were clustered along thoracic and lumbar vertebrae. Measure of agreement between radiological and histopathological diagnosis using kappa statistics revealed almost perfect agreement for extradural spinal SOLs and moderate agreement for intradural intramedullary and intradural extra medullary SOLs.   Conclusion: Comprehensive evaluation of spinal SOLs warrants multidisciplinary approach. Rapid advancements in radiology optimised diagnostic evaluation of non-neoplastic SOLs, however we conclude that histopathological evaluation is still the gold standard for diagnosis of primary spinal cord tumours and for planning the treatment and predicting prognosis.  

Imaging of Tuberculosis

1996 ◽  
Vol 37 (3P2) ◽  
pp. 506-511 ◽  
Author(s):  
S. Lindahl ◽  
R. S. Nyman ◽  
J. Brismar ◽  
C. Hugosson ◽  
C. Lundstedt
Keyword(s):  
Differential Diagnosis ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Soft Tissue Mass ◽  
Spinal Tuberculosis ◽  
Common Finding ◽  
Spinal Tumors ◽  
Tissue Mass ◽  
Radiologic Findings ◽  
Spinal Infections

Purpose: To describe the radiologic findings in patients with spinal tuberculosis (TB). Material and Methods: Out of a total of 503 patients with TB, 63 (13%) had involvement of the spine. Results: In 40 patients, the spine was the only location; 20 patients had concomitant chest TB. Conventional radiographs gave a good overview, CT visualized the diskovertebral lesions and the paravertebral abscesses, while MR imaging was useful to determine the spread of disease to the soft tissues and the spinal canal. The typical findings were destroyed vertebrae with associated paraspinal soft-tissue mass, with or without abscess formation, sometimes also involving the epidural space together with adjoining disk lesion and focal gibbus formation. Involvement of a single vertebra was a relatively common finding. Large psoas abscesses could occur without any signs of bone involvement. The TB process could sometimes be indistinguishable from malignant processes, and in 3 patients, with multiple lesions in the spine, it mimicked metastatic disease. Conclusion: It is stressed that TB should always be considered in the differential diagnosis when radiologic findings suggest spinal infections or primary or secondary spinal tumors.

scholarly journals Histopathological Audit of 373 Nononcological Hysterectomies in a Teaching Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Kanwardeep Kaur Tiwana ◽  
Sarita Nibhoria ◽  
Tanvi Monga ◽  
Richa Phutela
Keyword(s):  
Preoperative Diagnosis ◽  
Health Care Services ◽  
Histopathological Examination ◽  
Treatment Modalities ◽  
Common Finding ◽  
Kappa Statistics ◽  
Histopathological Diagnosis ◽  
Care Services ◽  
One Year

Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45±9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.

scholarly journals Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

2021 ◽  
Author(s):  
Sebastian Zensen ◽  
Sumitha Selvaretnam ◽  
Marcel Opitz ◽  
Denise Bos ◽  
Johannes Haubold ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Bone Biopsy ◽  
Lumbar Vertebrae ◽  
Bone Lesions ◽  
Anatomical Location ◽  
Thoracic Vertebrae ◽  
Level Of Evidence ◽  
Ct Guided ◽  
Bone Biopsies

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

scholarly journals Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 636
Author(s):  
Masato Tanaka ◽  
Sumeet Sonawane ◽  
Koji Uotani ◽  
Yoshihiro Fujiwara ◽  
Kittipong Sessumpun ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Standard Technique ◽  
Percutaneous Biopsy ◽  
Technical Note ◽  
Spinal Tumors ◽  
Histopathological Diagnosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

Gout in the Axial Skeleton

2009 ◽  
Vol 36 (3) ◽  
pp. 609-613 ◽  
Author(s):  
RUKMINI M. KONATALAPALLI ◽  
PAUL J. DEMARCO ◽  
JAMES S. JELINEK ◽  
MARK MURPHEY ◽  
MICHAEL GIBSON ◽  
...  
Keyword(s):  
Facet Joint ◽  
Case Reports ◽  
Case Series ◽  
Lumbar Vertebrae ◽  
Axial Skeleton ◽  
Ct Images ◽  
Common Finding ◽  
Appendicular Skeleton ◽  
Pars Interarticularis ◽  
A Prospective Study

Objective.Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.Methods.Six hundred thirty medical records with ICD codes 274.0, 274.82, and 274.9 for peripheral gout were reviewed. Ninety-two patients had clinical or crystal-proven gout, of which 64 had prior computed tomography (CT) images of the spine performed for various medical reasons. These CT images were reviewed for features of axial gout, which include vertebral erosions mainly at the discovertebral junction and the facet joints, deposits of tophi, and erosions in the vertebral body, epidural space, ligamentum flavum and pars interarticularis.Results.Nine of the 64 patients had radiographic changes suggestive of axial gout. Lumbar vertebrae were most commonly involved, with facet joint erosions being the most common finding. Isolated involvement of the sacroiliac joints was seen in 2 patients. Axial gout had been diagnosed clinically in only one patient.Conclusion.Radiologic changes of axial gout were more common than recognized clinically, with a frequency of 14%. Since not all patients had CT images, it is possible that the frequency of axial involvement was even greater. A prospective study is needed to further define this process.

Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: A scoping review

2021 ◽  
Author(s):  
Julio C Furlan ◽  
Jefferson R Wilson ◽  
Eric M Massicotte ◽  
Arjun Sahgal ◽  
Fehlings G Michael
Keyword(s):  
Spinal Cord ◽  
Scoping Review ◽  
Clinical Studies ◽  
Spinal Metastasis ◽  
Spinal Cord Tumor ◽  
Treatment Strategies ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Spinal Neoplasms ◽  
Primary Tumors

Abstract The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February/2000 to December/2020. The terms “spinal cord tumor”, “spinal metastasis”, and “metastatic spinal cord compression” were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n=101), Europe (n=43), Asia (n=24) or other continents (n=6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n=33), radiotherapy (n=21), chemotherapy (n=20), and surgical technique (n=11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed towards the metastatic population as opposed to the primary tumours which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.

scholarly journals An Audit of Indications for Hysterectomy in a District Hospital, Madikeri

2020 ◽  
Author(s):  
Sumanashree Mallappa ◽  
Aishwarya Ramanujam ◽  
Priyadarshini Monnappa ◽  
Padmaja Kulkarni
Keyword(s):  
District Hospital ◽  
Cross Sectional Study ◽  
Common Type ◽  
Common Finding ◽  
Histopathological Diagnosis ◽  
Fallopian Tubes ◽  
Cross Sectional ◽  
Histopathological Findings ◽  
Abdominal Approach ◽  
Nonsurgical Management

Introduction: Hysterectomy is the removal of the uterus and is the most common gynaecological operation done in females worldwide. In the early 20th century, hysterectomies were done for many conditions like leiomyoma, Dysfunctional Uterine Bleeding (DUB), chronic pelvic pain, endometriosis, adenomyosis, prolapse, and malignancies. Considering that the procedure has a 20-35% life risk, it calls for a thorough justification before consideration. A hysterectomy has mental, physical, social, economic and psychosexual impact, apart from intraoperative and postoperative complications. Thus, an audit on hysterectomies was done to help students, medical fraternity, and the women of Kodagu in having a better understanding of hysterectomies. Aim: To conduct an audit on hysterectomies performed for gynaecological indications to correlate pre-operative diagnosis with the histopathological diagnosis. Materials and Methods: This was a cross-sectional study which included all elective hysterectomies performed for gynaecological indications conducted at the District Hospital of Kodagu Institute of Medical Sciences, Madikeri from January 2018-June 2019. All cases of hysterectomies were considered except Caesarean peripartal hysterectomies. The histopathological findings of the endometrium, myometrium, cervix, ovaries and fallopian tubes were recorded. Findings were tabulated as frequency and percentage. Then, using the data, preoperative indications were compared with postoperative histopathological findings to know if hysterectomy was justified. Results: A total of 238 hysterectomies were performed during 18 months in the District Hospital. Abdominal and vaginal approaches were used. Panhysterectomy via abdominal approach was the most common type of hysterectomy. The most common age group where hysterectomy occurred was 41-60 years. The most common indication for hysterectomy was found to be Fibroid uterus. Analysis of the myometrial findings revealed that the most common finding was leiomyoma. Majority of ovaries and fallopian tubes did not show significant pathology. Conclusion: Panhysterectomy was the most common type of hysterectomy. Fibroid were the most common histopathological findings and medium and small sized fibroids can be given a trial of nonsurgical management. Injudicious use of hysterectomy procedure has multiple loop holes involving medical fraternity, socioeconomic conditions of women and attitude of society towards female reproductive health.

scholarly journals Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

2020 ◽  
Vol 8 (B) ◽  
pp. 76-80
Author(s):  
Moneer K. Faraj ◽  
Bassam Mahmood Flamerz  Arkawazi ◽  
Hazim Moojid Abbas ◽  
Zaid Al-Attar
Keyword(s):  
Functional Outcome ◽  
Vertebral Body ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Spinal Tuberculosis ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Karnofsky Performance Status Scale ◽  
Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

HISTOPATHOLOGICAL SPECTRUM OF SKIN LESIONS: A TWO YEAR RETROSPECTIVE STUDY.

2021 ◽  
pp. 26-29
Author(s):  
Shruti Shemawat ◽  
Sakshi Apurva ◽  
D.P Soni ◽  
Saurabh Soni
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Relative Frequency ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Benign Tumors ◽  
Histopathological Diagnosis ◽  
Neoplastic Lesions ◽  
Skin Biopsies ◽  
Age And Sex

INTRODUCTION: The skin being largest organ of the body has vast spectrum of disorders which can be difcult to diagnose correctly solely on the basis of clinical features. Hence histopathological examination is necessary to categorise skin lesions. The aim was to study relative frequency of various skin lesions and distribution of these lesions according to age and sex. METHODS: This is a retrospective descriptive hospital based study. The skin biopsies samples which came in the duration of two years from January 2019 to December 2020 at the Department of Pathology, Sardar Patel Medical college and associated group of hospitals, Bikaner, Rajasthan were taken in this study. All skin biopsies that showed denite histopathological diagnosis were included. After proper xing and staining procedures these lesions were examined under light microscopy and categorized as non-neoplastic and neoplastic. Relative frequency of various lesions, distribution of lesions according to age and sex was analyzed. The data collected was tabulated, interpreted and compared with other similar studies. RESULTS: Out of 346 patients, incidence of neoplastic lesions 259 (74.9%) were higher than non-neoplastic lesions 87(25.1%). Males were affected more compared to females with male to female ratio 1.45:1. Non-neoplastic lesions were mostly caused because of infectious etiologies among which leprosy was the most common infection. Keratinocytic tumors 99(52.2%) constituted most common type of neoplastic lesion. Benign tumors 191(73.7%) outnumbered malignant tumors 68(26.3%). The cases of benign tumors were seen more in younger population while that of malignant tumors were seen in older age groups. Among the keratinocytic type of malignant skin tumors squamous cell carcinoma (63.5%) was the most common variant which was followed by basal cell carcinoma 19(36.5%). Male predominance was observed in both squamous cell carcinoma and basal cell carcinoma. CONCLUSION: A wide heterogenesity of skin lesions was observed in the present study . These skin lesions were mostly affecting age group of 10-30 years. Inspite of extensive programmes and research, leprosy and tuberculosis remains a rampant cause of infectious non-neoplastic skin lesions. Sometimes ignorance by patient for a very small appearing skin lesions becomes life threatening. Hence early clinician consultation with proper examination and accurate histopathological diagnosis becomes the mainstay in early treatment and recovery.

The locomotor system

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Vertebral Column ◽  
Cervical Vertebrae ◽  
Lumbar Vertebrae ◽  
Posterior Wall ◽  
Axial Skeleton ◽  
Intervertebral Discs ◽  
Central Canal ◽  
The Body ◽  
Thoracic Vertebrae ◽  
Locomotor System

The locomotor system comprises the skeleton, composed principally of bone and cartilage, the joints between them, and the muscles which move bones at joints. The skeleton forms a supporting framework for the body and provides the levers to which the muscles are attached to produce movement of parts of the body in relation to each other or movement of the body as a whole in relation to its environment. The skeleton also plays a crucial role in the protection of internal organs. The skeleton is shown in outline in Figure 2.1A. The skull, vertebral column, and ribs together constitute the axial skeleton. This forms, as its name implies, the axis of the body. The skull houses and protects the brain and the eyes and ears; the anatomy of the skull is absolutely fundamental to the understanding of the structure of the head and is covered in detail in Section 4. The vertebral column surrounds and protects the spinal cord which is enclosed in the spinal canal formed by a large central canal in each vertebra. The vertebral column is formed from 33 individual bones although some of these become fused together. The vertebral column and its component bones are shown from the side in Figure 2.1B. There are seven cervical vertebrae in the neck, twelve thoracic vertebrae in the posterior wall of the thorax, five lumbar vertebrae in the small of the back, five fused sacral vertebrae in the pelvis, and four coccygeal vertebrae—the vestigial remnants of a tail. Intervertebral discs separate individual vertebrae from each other and act as a cushion between the adjacent bones; the discs are absent from the fused sacral vertebrae. The cervical vertebrae are small and very mobile, allowing an extensive range of neck movements and hence changes in head position. The first two cervical vertebrae, the atlas and axis, have unusual shapes and specialized joints that allow nodding and shaking movements of the head on the neck. The thoracic vertebrae are relatively immobile. combination of thoracic vertebral column, ribs, and sternum form the thoracic cage that protects the thoracic organs, the heart, and lungs and is intimately involved in ventilation (breathing).

Sign in / Sign up

Export Citation Format

Share Document