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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Treatment is by excisional biopsy, wide local excision and possibly sentinel node biopsy. Spread of disease to local lymph nodes or distant sites (typically brain, bone, skin and lung) marks a decidedly poor prognosis.
PTGC is treated by excisional biopsy and follow-up. It may occasionally recur and in a small proportion of patients has been reported to subsequently develop Hodgkin lymphoma (usually nodular lymphocyte predominant Hodgkin lymphoma).
It can be detected by magnetic resonance imaging (MRI), but a biopsy is required for the definitive diagnosis. MRI findings typically show a well-circumscribed mass that is dark on T1-weighted images and bright on T2-weighted images. Central necrosis is often present and identifiable by imaging, especially in larger masses.
Inflammatory myofibroblastic tumours are diagnosed based on their appearance under the microscope, by pathologists. Medical imaging findings are non-specific.
Most histiocytomas will regress within two or three months. Surgical removal may be necessary if the tumor does not regress or if it is growing rapidly to a large size. Histiocytomas should never be treated with an intralesional injection of a corticosteroid, as remission relies on recognition of the tumour by the body's immune system which is suppressed by steroids.
PTGCs is characterized by:
- follicular hyperplasia (many follicles),
- focally large germinal centres, with poorly demarcated germinal centre (GC)/mantle zone interfaces (as GCs infiltrated by mantle zone lymphocytes), and
- an expanded mantle zone.
Most commonly histiocytomas are found in young dogs and appear as a small, solitary, hairless lump, although Shar Peis may be predisposed to multiple histiocytomas. They are most commonly found on the head, neck, ears, and limbs, and are usually less than 2.5 cm in diameter. Ulceration of the mass is common. Diagnosis is made through cytology of the mass. Cytology reveals cells with clear to lightly basophilic cytoplasm and round or indented nuclei with fine chromatin and indistinct nucleoli.
They are benign lesions and malignant degeneration is rare. They are usually treated with curettage which however have a high recurrence rate of 25%. As such if an en-bloc resection is possible this is advisable
Undifferentiated pleomorphic sarcomas are, by definition, "undifferentiated", meaning (as the name implies) that they do not bear a resemblance to any normal tissue.
The histomorphology, otherwise, is characterized by high cellularity, marked nuclear pleomorphism, usually accompanied by abundant mitotic activity (including atypical mitoses), and a spindle cell morphology. Necrosis is common and characteristic of high grade lesions.
Inflammatory myofibroblastic tumours are characterized by a mix of inflammatory cells, e.g. plasma cells, lymphocytes and eosinophils, and bland spindle cells without nuclear atypia. These tumours may have necrosis, hemorrhage, focal calcification and mitotic activity.
The histologic differential diagnosis includes:
- calcifying fibrous pseudotumour
- inflammatory fibroid tumour
- nodular fasciitis.
Approximately half of IMTs have a rearrangement of the ALK gene.
Eccrine angiomatous hamartoma usually appear as a solitary nodular lesion on the acral areas of the extremities, particularly the palms and soles.
Superficial spreading melanoma (also known as "superficially spreading melanoma") (SSM) is usually characterized as the most common form of cutaneous melanoma in Caucasians. The average age at diagnosis is in the fifth decade, and it tends to occur on sun-exposed skin, especially on the backs of males and lower limbs of females.
It is characterized cystic blood-filled spaces and composed of histiocyte-like cells. A lymphocytic cuff is common. It often simulates a vascular lesion, and was initially described as doing this.
AFH typically has a chromosomal translocation involving the ATF1 gene -- t(12;16) FUS/ATF1 or t(12;22) EWS/ATF1.
A histiocytoma is a tumour consisting of histiocytes. Histiocytes are cells that are a part of the mononuclear phagocytic system, a part of the body's immune system that consists of phagocytic cells, which are responsible for engulfing solid particles by the cell membrane to form an internal phagosome by phagocytes and protists.
Types include:
- myxofibrosarcoma
- benign fibrous histiocytoma
- malignant fibrous histiocytoma
- histiocytoma (dog)
Angiomatoid fibrous histiocytoma, abbreviated AFH, is a rarely metastasizing tumour that affects children and young adults.
Plain film
often seen as a lobulated, eccentric radiolucent lesion
long axis parallel to long axis of long bone
no periosteal reaction (unless a complicating fracture present)
geographic bone destruction: almost 100%
well defined sclerotic margin: 86%
there can be presence of septations (pseudotrabeculation): 57% 2
there can be presence of matrix calcification in a small proportion of cases: 12.5%1
MRI
MR features are often not particularly specific. Signal characteristics include
T1 - low signal
T1 C+ (Gd) -
the majority (~70%) tend to show peripheral nodular enhancement
~ 30% diffuse contrast enhancement and this can be either homogeneous or heterogeneous 19
T2 - high signal
Bone scan
A scintigraphic "doughnut sign" has been described in this tumour type 11. However, this is very non-specific and can be found in a plethora of other bone lesions.
Until recently, nodular fasciitis have been considered a reactive process of uncertain cause. However, recent findings indicate that nodular fasciitis is a self-limited clonal neoplastic process (see below). Clinically, nodular fasciitis presents as a subcutaneous "growth" over a period of 3–6 weeks that eventually regresses. The lesion usually reaches a size of 2–3 cm. Larger lesions are unusual. Local recurrence has been described after simple surgical excision but it is rare.
Therapies for metastatic melanoma include the biologic immunotherapy agents ipilimumab, pembrolizumab, and nivolumab; BRAF inhibitors, such as vemurafenib and dabrafenib; and a MEK inhibitor trametinib.
In longstanding scarred lesions, squamous cell carcinoma can develop.
Diagnosis is based on visual examination and the presence of itching. A skin biopsy is often performed to exclude other diseases. Lesion biopsies will typically show a high level of eosinophils in PN. A culture of at least one lesion will rule out staphylococcus infection, which has been significantly linked to atopic dermatitis.
Nodular fasciitis, also known as nodular pseudosarcomatous fasciitis, pseudosarcomatous fasciitis, and subcutaneous pseudosarcomatous fibromatosis, is a benign soft tissue lesion most commonly found in the superficial fascia. The lesion commonly occurs in the first three decades of life. Upper extremities and trunk are the most common affected anatomical sites. Previous history of trauma may be present. Clinically and histologically, nodular fasciitis may be mistaken for a sarcoma.
Progressive nodular histiocytoma is a cutaneous condition characterized by generalized, discrete yellow papules and nodules with prominent facial involvement.
Progressive nodular histiocytosis is a cutaneous condition clinically characterized by the development of two types of skin lesions: superficial papules and deeper larger subcutaneous nodules.
Trichoblastomas are a cutaneous condition characterized by benign neoplasms of follicular germinative cells. Trichoblastic fibroma is a designation used to characterize small nodular trichoblastomas with conspicuous fibrocytic stroma, sometimes constituting over 50% of the lesion.
Generalized eruptive histiocytoma (also known as "Eruptive histiocytoma," and "Generalized eruptive histiocytosis") is a rare cutaneous condition characterized by widespread, erythematous, essentially symmetrical papules, particularly involving the trunk and proximal extremities.