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Smooth Muscle Hamartoma

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81. Peutz-Jeghers Syndrome (Follow-up)

syndrome are typical hamartomas. Their histology is characterized by extensive smooth muscle arborization throughout the polyp. [ , ] This may give the lesion the appearance of pseudoinvasion, because some of the epithelial cells, usually from benign glands, are surrounded by the smooth muscle (the lack of dysplasia in the polyps help to differentiate pseudoinvasion from malignancy). [ , ] Cancer develops in the gastrointestinal tract of patients with Peutz-Jeghers syndrome with a higher frequency than (...) of a “clean-sweep” strategy for disease surveillance or because they are resulting in symptoms, including bleeding. Previous Next: Histologic Findings Polyps in Peutz-Jeghers syndrome (PJS) can reliably be differentiated from other types of polyps only by histopathology, [ ] and surgical pathologists can have a critical role in recommending genetic counseling and surveillance of the patient and/or family members when the diagnosis is suspected. [ ] Smooth-muscle hyperplasia, with an elongated, arborized

2014 eMedicine.com

82. Asthma (Overview)

in the United States. The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia (...) , and airway remodeling are present. [ , ] Airway hyperresponsiveness or bronchial hyperreactivity in asthma is an exaggerated response to numerous exogenous and endogenous stimuli. The mechanisms involved include direct stimulation of airway smooth muscle and indirect stimulation by pharmacologically active substances from mediator-secreting cells such as mast cells or nonmyelinated sensory neurons. The degree of airway hyperresponsiveness generally correlates with the clinical severity of asthma

2014 eMedicine.com

83. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

, and Skene ducts. Different epithelia, from keratinized squamous epithelium to squamous mucosa, cover the vulva. The labia minora are rich with sebaceous glands but have few sweat glands and no hair follicles. The epithelium of the vestibule is neither pigmented nor keratinized and contains eccrine glands. Benign vulvar disorders are a significant issue for patients. These disorders include vulvar atrophy, benign tumors, hamartomas and cysts, infectious disorders, and nonneoplastic epithelial disorders (...) : , lentiginosis, and benign vulvar melanosis Postinflammatory hypopigmentation Vulvar melanosis [ ] Benign tumors, hamartomas, and cysts involving the vulvar region include the following [ ] : Bartholin and Skene duct cysts (fibroepithelial polyp) Fibroma, fibromyoma, and dermatofibroma Hidradenoma Syringoma Hemangioma Angiokeratoma Heterotopic sebaceous glands and sebaceous gland hyperplasia Papillomatosis (papillary vulvar hirsutism) Schwannoma [ ] Angiomyxoma: a benign and aggressive mesenchymal tumor

2014 eMedicine.com

84. Breast, Fibroadenoma

and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. When internal septa are present in a smooth mass, the confidence that the mass is a fibroadenoma is high. When septa are not present, the findings of fibroadenomas (...) because of its high cost and the high likelihood of false-positive findings. [ , , , , ] Positron emission tomography is expensive and is not universally available. On mammograms, fibroadenomas typically appear as circumscribed oval or round masses, which occasionally have coarse calcifications. On ultrasonograms, fibroadenomas appear as circumscribed, homogeneous, oval, hypoechoic masses that may have gentle lobulations; a smooth, thin, echogenic capsule; variable acoustic enhancement

2014 eMedicine Radiology

85. Breast Cancer, Mammography

. The presence of very low density fat in a lesion often indicates benign findings such as oil cysts, lipomas, galactoceles, and hamartomas. Calcifications can also be the first sign of cancer or a harmless process in the breast. Benign calcifications are usually larger than calcifications associated with malignancy. They are usually coarser, often round with smooth margins, and more easily seen. Benign calcifications tend to have specific shapes: eggshell calcifications in cyst walls, tramlike in arterial (...) finding, palpation-guided biopsy may still be indicated. The use of sonography as an adjuvant to mammography may increase accuracy by up to 7.4%. [ ] On sonograms, solid lesions with smooth or gently lobulated margins that are sharply defined, with homogeneous hypoechoic contents and an orientation parallel to the chest wall, are usually benign. Solid hypoechoic lesions with irregular margins, an orientation perpendicular to the chest wall, acoustic shadowing are suspicious, and biopsy is indicated

2014 eMedicine Radiology

86. Mesenteric Tumors (Diagnosis)

, Kovatich AJ, Carr NJ, Emory TS, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol . 1999 Sep. 23 (9):1109-18. . Seow-Choen F. The management of desmoids in patients with familial adenomatous polyposis (FAP). Acta Chir Iugosl . 2008. 55 (3):83-7. . Clark SK, Phillips RK. Desmoids in familial adenomatous polyposis. Br J Surg . 1996 Nov. 83 (11):1494-504. . Caspari R (...) is palpated on physical examination. It is very amenable to surgical excision, though local recurrence has been described. Other benign neoplasms of the mesentery are exceedingly rare, but tumors of neural origin, hamartomas, [ ] and stromal tumors of small size with nonaggressive clinical behavior have been described. Malignant mesenteric tumors A relatively few tumor types account for the vast majority of mesenteric malignancies; in these malignancies, the small-bowel mesentery is almost exclusively

2014 eMedicine Surgery

87. Benign Neoplasm of the Small Intestine (Diagnosis)

, et al. "Brunneroma": hamartoma or tumor?. Pathol Res Pract . 1986 Mar. 181(1):107-11. . Bremer EH, Battaile WG, Bulle PH. Villous tumors of the upper gastrointestinal tract. Clinical review and report of a case. Am J Gastroenterol . 1968 Aug. 50(2):135-43. . Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg . 1997 May. 173(5):390-4. . He LJ, Wang BS, Chen CC. Smooth muscle tumours of the digestive tract: report of 160 cases. Br J Surg . 1988 Feb. 75(2):184-6 (...) . . Morgan BK, Compton C, Talbert M, et al. Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience. Ann Surg . 1990 Jan. 211(1):63-6. . Amin MB, Ma CK, Linden MD, et al. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol . 1993 Oct. 100(4):428-32. . Nincheri Kunz M, Evaristi L, Spadoni R, et al. [Lipoma of the small intestine as a rare cause of intestinal occlusion]. Minerva

2014 eMedicine Surgery

88. Tuberous Sclerosis

, which has the histologic features of an angiomyolipoma, is one of the primary manifestations of renal involvement. Hamartomas contain varying amounts of mature adipose tissue, smooth muscle, and blood vessels and usually develop in young adults and enlarge slowly. Usually, hamartomas are asymptomatic; however, they can cause flank pain, hematuria, or an abdominal mass, which may be palpable. Hamartomas usually are multiple and bilateral. Malignant degeneration of hamartomas into renal cell carcinoma (...) appearance occurs in less than half of patients, probably in one third. Abnormal radiologic findings are important in diagnosing this disease and include CNS lesions of cortical hamartomas, white-matter abnormalities, and subependymal nodules (ie, hamartomas). Patients also have subependymal giant cell . These intracranial neoplasms can result in obstructive . Retinal lesions, nonatheromatous vascular stenoses and aneurysms, and mild ventricular enlargement without astrocytomas can be present. Tuberous

2014 eMedicine Radiology

89. Benign Neoplasm of the Small Intestine (Overview)

, et al. "Brunneroma": hamartoma or tumor?. Pathol Res Pract . 1986 Mar. 181(1):107-11. . Bremer EH, Battaile WG, Bulle PH. Villous tumors of the upper gastrointestinal tract. Clinical review and report of a case. Am J Gastroenterol . 1968 Aug. 50(2):135-43. . Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg . 1997 May. 173(5):390-4. . He LJ, Wang BS, Chen CC. Smooth muscle tumours of the digestive tract: report of 160 cases. Br J Surg . 1988 Feb. 75(2):184-6 (...) . . Morgan BK, Compton C, Talbert M, et al. Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience. Ann Surg . 1990 Jan. 211(1):63-6. . Amin MB, Ma CK, Linden MD, et al. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol . 1993 Oct. 100(4):428-32. . Nincheri Kunz M, Evaristi L, Spadoni R, et al. [Lipoma of the small intestine as a rare cause of intestinal occlusion]. Minerva

2014 eMedicine Surgery

90. Asthma

in diameter, and 4- to 6-mm airways had a 59% reduction. Wall thickening was believed to result, in part, from increased bronchial blood flow, edema, and smooth muscle hyperplasia. The lower range of visibility was at the generally accepted maximal diameter of small airways, that is, 2 mm. [ ] Herold et al established the usefulness of HRCT in measuring the bronchial response to bronchoconstrictors in the setting of hyperreactivity. Responses to aerosol isotonic sodium chloride solution and histamine were (...) and outer wall, smooth muscle, mucous gland, and cartilage were greater in fatal cases of asthma than in control and nonfatal cases. [ ] The internal size of segmental to sixth-generation bronchi was studied in healthy control subjects by using HRCT. Measurements ranged from 0.8-8 mm in diameter, with the use of 2-HU windows, 5X optical magnification, and automated luminal area calculation. The authors used a 2-HU window to clarify the edges of the bronchial walls to enhance the reproducibility

2014 eMedicine Radiology

91. Liver, Metastases

bones or ribs; and muscle weakness. Diseases that may be confused with liver metastases include the following: hemangioma, FNH, HCC, hepatocellular adenoma, liver cyst, biliary hamartoma, biliary cystadenoma, intrahepatic cholangiocarcinoma, angiosarcoma, epithelioid hemangioendothelioma, primary hepatic lymphoma, focal fatty infiltration and focal fatty sparing, lipoma, and inflammatory pseudotumor. These diseases are described below. In addition, Mn-DPDP enhancement has been reported in HCC (...) margins and (2) a smooth or irregular central area of high signal intensity with a surrounding ring of signal intensity lower than that of the central focus but higher than that of the adjacent normal liver. Intravenous contrast agents improve the detection of liver mass lesions. MRI contrast agents and contrast-enhanced techniques The contrast agents available for use in liver imaging may be classified into 4 groups according to their biologic distribution: Gadolinium chelates, which have

2014 eMedicine Radiology

92. Mammography - Computer-Aided Detection

various authors and the architectural interpretation model developed by Nunes et al in 1997. PPV indicates positive predictive value. *Sherif [ ] †Nunes [ ] Table 3. Breast MRI Criteria for Benign Processes Criterion Statistic Value, % Minimal enhancement Specificity >95 Mild regional enhancement NPV 92 No enhancing lesion NPV 99 Smooth borders NPV 93 Lobulated enhancing nonseptate mass with low T2 intensity NPV 100 Lobulated mass with minimal enhancement NPV 100 Lobulated mass with non-enhancing (...) parenchyma enhances more strongly in the 35-50 year age range. The enhancement is least in the second and third weeks of the menstrual cycle. [ ] Nonspecific, focal areas of enhancement may resolve or fluctuate in size from month to month. [ , ] Nipple and areola Normal nipples usually show a smooth thin rim of enhancement and are symmetrical bilaterally. The normal nipple may enhance intensely and rapidly. Retroareolar ducts may enhance normally, though usually not as intensely. These changes can make

2014 eMedicine Radiology

93. Magnetic Resonance Mammography

various authors and the architectural interpretation model developed by Nunes et al in 1997. PPV indicates positive predictive value. *Sherif [ ] †Nunes [ ] Table 3. Breast MRI Criteria for Benign Processes Criterion Statistic Value, % Minimal enhancement Specificity >95 Mild regional enhancement NPV 92 No enhancing lesion NPV 99 Smooth borders NPV 93 Lobulated enhancing nonseptate mass with low T2 intensity NPV 100 Lobulated mass with minimal enhancement NPV 100 Lobulated mass with non-enhancing (...) parenchyma enhances more strongly in the 35-50 year age range. The enhancement is least in the second and third weeks of the menstrual cycle. [ ] Nonspecific, focal areas of enhancement may resolve or fluctuate in size from month to month. [ , ] Nipple and areola Normal nipples usually show a smooth thin rim of enhancement and are symmetrical bilaterally. The normal nipple may enhance intensely and rapidly. Retroareolar ducts may enhance normally, though usually not as intensely. These changes can make

2014 eMedicine Radiology

94. Skin, Benign Skin Lesions

, the epithelium is well differentiated and has an abundant ground-glass cytoplasm. At the margin, evidence of a pushing edge is present. This is characterized by an inflammatory rim with extension into the muscle. Perineural and vascular invasion also can be observed. Immunohistochemical staining can help differentiate keratoacanthomas from other epidermal carcinomas. Filaggrin is a histidine-rich protein that is found in the horny and granule layers of the dermis. It is ubiquitous in keratoacanthoma (...) , hairless plaques. An accelerated growth phase may be observed during adolescence secondary to changes in the hormonal milieu. The natural history of this lesion includes an evolution from a smooth, featureless lesion into a verrucous, thickened plaque with crusting and ulceration. Complete surgical excision is the treatment of choice. Seborrheic keratosis Seborrheic keratosis (SK), also known as seborrheic wart, senile keratosis, and basal cell papilloma, [ , ] is a benign, noninvasive, hyperplastic

2014 eMedicine Surgery

95. Solitary Pulmonary Nodule (Follow-up)

, marblelike consistency. Histologically, hamartomas generally consist of epithelial tissue and other tissues, such as fat and cartilage. Hamartomas can be easily enucleated, but wedge resection is also appropriate. Hamartomas consist of haphazardly organized mature cells and tissues. Hamartomas are composed mostly of masses of hyaline cartilage with a myxoid connective tissue, adipose cells, smooth muscle cells, and clefts lined with respiratory epithelium. See the image below. A right lower lobe solitary (...) pulmonary nodule is the the best chance for cure. Benign lung tumors Benign lung tumors are a heterogenous group of neoplastic lesions originating from pulmonary structures. These tumors include bronchial adenomas, hamartomas, and a group of uncommon neoplasms (eg, chondromas, fibromas, lipomas, leiomyomas, hemangiomas, teratomas, pseudolymphomas, endometrioma, and bronchial glomus tumors). Although benign lung tumors do not pose a significant health problem, complications can result if an obstructive

2014 eMedicine.com

96. Angioma Serpiginosum (Follow-up)

-Juanes-Jimenez J. [Six cases of nevus oligemicus]. Actas Dermosifiliogr . 2008 May. 99(4):301-4. . Vivehanantha S, Browne F, Bowen C, Brundler MA, Hughes J, Moss C, et al. A congenital smooth muscle hamartoma masquerading as a reticulate vascular naevus. Clin Exp Dermatol . 2013 Jun 13. . Miura T, Yamamoto T. Pediatric linear scleroderma initially developed with angioma serpiginosum-like appearances. J Dermatol . 2015 May 11. . Polla LL, Tan OT, Garden JM, Parrish JA. Tunable pulsed dye laser

2014 eMedicine.com

97. Solitary Pulmonary Nodule (Diagnosis)

, marblelike consistency. Histologically, hamartomas generally consist of epithelial tissue and other tissues, such as fat and cartilage. Hamartomas can be easily enucleated, but wedge resection is also appropriate. Hamartomas consist of haphazardly organized mature cells and tissues. Hamartomas are composed mostly of masses of hyaline cartilage with a myxoid connective tissue, adipose cells, smooth muscle cells, and clefts lined with respiratory epithelium. See the image below. A right lower lobe solitary (...) pulmonary nodule is the the best chance for cure. Benign lung tumors Benign lung tumors are a heterogenous group of neoplastic lesions originating from pulmonary structures. These tumors include bronchial adenomas, hamartomas, and a group of uncommon neoplasms (eg, chondromas, fibromas, lipomas, leiomyomas, hemangiomas, teratomas, pseudolymphomas, endometrioma, and bronchial glomus tumors). Although benign lung tumors do not pose a significant health problem, complications can result if an obstructive

2014 eMedicine.com

98. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Follow-up)

some or all of the TZ. Such calcifications have been correlated with a history of prostatitis but are often seen in healthy young men with no history of prostatic inflammation. The preprostatic sphincter, composed of the bladder neck and periurethral tissue, is located between the 2 lobes of the TZ. This structure demonstrates the dramatic hypoechogenicity typical of muscle due to the concentration of smooth muscle fibers. These muscles appear as an inverted Y, which has been termed the Eiffel (...) , this variant gives the appearance of bilateral basilar hypoechogenicity. In 12% of patients, abnormal penetration of the seminal vesicles and vas deferens was present at the rectal surface of the prostate, characterized by a lack of CZ tissue posterior to these structures, which sonographically appeared as midline hypoechogenicity at the base of the prostate. In 6% of cases, abnormally large (>2 mm in diameter) smooth muscle bundles were present within the ejaculatory duct sheath, which also produced

2014 eMedicine.com

99. Angioma Serpiginosum (Diagnosis)

Dermosifiliogr . 2008 May. 99(4):301-4. . Vivehanantha S, Browne F, Bowen C, Brundler MA, Hughes J, Moss C, et al. A congenital smooth muscle hamartoma masquerading as a reticulate vascular naevus. Clin Exp Dermatol . 2013 Jun 13. . Miura T, Yamamoto T. Pediatric linear scleroderma initially developed with angioma serpiginosum-like appearances. J Dermatol . 2015 May 11. . Polla LL, Tan OT, Garden JM, Parrish JA. Tunable pulsed dye laser for the treatment of benign cutaneous vascular ectasia. Dermatologica

2014 eMedicine.com

100. Glomus Tumor (Diagnosis)

, with most cases involving subungual sites. These tumors are characteristically painful, often causing paroxysmal pain in response to temperature changes (especially cold) or pressure. Note the images below. Glomus tumor. Multiple glomus tumors. Glomus tumors are thought to arise from the glomus body or Sucquet-Hoyer canal, a thermoregulatory arteriovenous shunt composed of modified smooth muscle cells. [ , ] Glomus tumors most frequently occur in areas with high concentrations of glomus bodies (...) canal), primary collecting vein, intraglomerular reticulum, and a capsular portion. These specialized arteriovenous anastomoses are particularly concentrated in the reticular dermis of the fingers. Glomus tumors are thought to represent hamartomatous proliferations of modified smooth muscle cells originating from preexisting normal glomus cell populations. The three components of most glomus tumors include glomus cells, vasculature, and smooth muscle cells. The most common type of glomus tumor

2014 eMedicine.com

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