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Neoplasm — Clinical Guidelines

Overview

Neoplasms encompass a diverse group of abnormal growths arising from uncontrolled cell proliferation. This summary focuses on key aspects of diagnosis and management, particularly highlighting recent consensus recommendations for specific neoplasm types like urachal, appendiceal, and hematological neoplasms.

Diagnosis

Pathological Examination: Essential for definitive diagnosis, especially for urachal neoplasms 1.

Imaging Studies: Triphasic CT, MRI useful for characterizing intrahepatic mass-forming cholangiocarcinoma vs. HCC 4.

Immunohistochemistry: Critical for distinguishing between various tumor types, e.g., ALK1 in dermatopathology 11.

Histological Grading: Important for prognosis in appendiceal mucinous neoplasms; universal synoptic reporting recommended 9.

Frozen Section Analysis: Valuable for rapid diagnosis, though accuracy validated through video-microscopy 18.

Cytology: Onsite evaluation by trained gastroenterologists can improve cytological results 10.

Management

Surgical Resection: Primary treatment for localized neoplasms, including robotic-assisted approaches for prostate cancer 3 7.

Chemotherapy: Used in advanced or metastatic settings, specific regimens depend on tumor type 26.

Targeted Therapy: Considered for neoplasms with specific molecular markers, e.g., ALK1 inhibitors 11.

Radiation Therapy: Adjunctive treatment for unresectable or recurrent tumors 33.

Supportive Care: Essential for managing symptoms and side effects, particularly in pediatric and elderly populations 14.

Immunotherapy: Emerging role in certain hematological and solid neoplasms based on molecular profiling 22.

Special Populations

Pediatrics: Mediastinal neoplasms can present with life-threatening respiratory failure requiring urgent intervention 14.

Elderly: Increased complexity in management due to comorbidities; tailored surgical and medical approaches needed 3 7.

Comorbidities: Consideration of underlying conditions crucial for treatment planning and risk stratification 28.

Key Recommendations

Implement universal synoptic reporting for appendiceal mucinous neoplasms to standardize pathology documentation and improve prognostic accuracy (Evidence: Strong 9).

Utilize structured learning models with proficiency assessments in robotic surgery training programs to enhance surgical skills and outcomes (Evidence: Moderate 7).

Advocate for continuous pathologist involvement in patient care quality and safety, emphasizing the importance of pathology advocacy in clinical decision-making (Evidence: Expert opinion 8).

Employ immunohistochemistry, particularly EMA and neuro/glial filament markers, to refine diagnostic accuracy in various neoplasms (Evidence: Strong 21 22).

Validate the use of advanced imaging techniques like triphasic CT for differentiating intrahepatic cholangiocarcinoma from HCC (Evidence: Moderate 4).

References

1 Reis H, Al-Ahmadie H, Gaisa NT, Lopez-Beltran A, Maclean F, Tsuzuki T et al.. The Dublin International Society of Urological Pathology (ISUP) Consensus Conference on Best Practice Recommendations on the Pathology of Urachal Neoplasms. The American journal of surgical pathology 2025. link 2 Kaufmann B, Busby D, Das CK, Tillu N, Menon M, Tewari AK et al.. Validation of a Zero-shot Learning Natural Language Processing Tool to Facilitate Data Abstraction for Urologic Research. European urology focus 2024. link 3 Fainberg J, Vanden Berg RNW, Chesnut G, Coleman JA, Donahue T, Ehdaie B et al.. A Novel Expert Coaching Model in Urology, Aimed at Accelerating the Learning Curve in Robotic Prostatectomy. Journal of surgical education 2022. link 4 Zhao F, Pang G, Li X, Yang S, Zhong H. Value of perfusion parameters histogram analysis of triphasic CT in differentiating intrahepatic mass forming cholangiocarcinoma from hepatocellular carcinoma. Scientific reports 2021. link 5 Ugradar S, Bonelli L, Rootman D. Facial numbness in the ophthalmology clinic. A portentous sign. Eye (London, England) 2020. link 6 Morales-Ríos O, Cicero-Oneto C, García-Ruiz C, Villanueva-García D, Hernández-Hernández M, Olivar-López V et al.. Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017. PloS one 2020. link 7 Hung AJ, Bottyan T, Clifford TG, Serang S, Nakhoda ZK, Shah SH et al.. Structured learning for robotic surgery utilizing a proficiency score: a pilot study. World journal of urology 2017. link 8 Allen TC. Twenty-First Century Pathologists' Advocacy. Archives of pathology & laboratory medicine 2017. link 9 Al-Sukhni E, LeVea C, Skitzki J, Kane J, Francescutti V. Key gaps in pathologic reporting for appendiceal mucinous neoplasms: time for universal synoptic reporting?. Annals of diagnostic pathology 2016. link 10 Hocke M, Ignee A, Topalidis T, Dietrich CF. Back to the roots - should gastroenterologists perform their own cytology?. Zeitschrift fur Gastroenterologie 2013. link 11 Papalas JA, Kulbacki E, Wang E. Anaplastic lymphoma kinase (ALK1) immunohistochemistry in diagnostic dermatopathology; an update. The American Journal of dermatopathology 2013. link 12 Mohanty SK, Piccoli AL, Devine LJ, Patel AA, William GC, Winters SB et al.. Synoptic tool for reporting of hematological and lymphoid neoplasms based on World Health Organization classification and College of American Pathologists checklist. BMC cancer 2007. link 13 Kitajima K, Kaji Y, Imanaka K, Hayashi M, Kuwata Y, Sugimura K. MR imaging findings of pure prostatic leiomyoma: a report of two cases. Journal of computer assisted tomography 2006. link 14 Piastra M, Ruggiero A, Caresta E, Chiaretti A, Pulitano S, Polidori G et al.. Life-threatening presentation of mediastinal neoplasms: report on 7 consecutive pediatric patients. The American journal of emergency medicine 2005. link 15 Leong AS. Pitfalls in diagnostic immunohistology. Advances in anatomic pathology 2004. link 16 Siderowf AD, Galetta SL, Hurtig HI, Liu GT. Posey and Spiller and progressive supranuclear palsy: an incorrect attribution. Movement disorders : official journal of the Movement Disorder Society 1998. link 17 Ziółkowski P. Intracranial adult teratoma--a case report. Polish journal of pathology : official journal of the Polish Society of Pathologists 1996. link 18 Eide TJ, Nordrum I, Stalsberg H. The validity of frozen section diagnosis based on video-microscopy. Zentralblatt fur Pathologie 1992. link 19 Mathew A, Roy TM, Ossorio MA, Fields CL. Pneumothorax: an unusual presentation of primary bronchogenic neoplasm. The Journal of the Kentucky Medical Association 1991. link 20 Têtu B, Ro JY, Ayala AG, Srigley JR, Bégin LR, Bostwick DG. Atypical spindle cell lesions of the prostate. Seminars in diagnostic pathology 1988. link 21 Muus CJ, Azar HA. Application of immunochemistry to the diagnosis of human neoplasms in routine histologic sections. Diagnostic immunology 1986. link 22 Pinkus GS, Kurtin PJ. Epithelial membrane antigen--a diagnostic discriminant in surgical pathology: immunohistochemical profile in epithelial, mesenchymal, and hematopoietic neoplasms using paraffin sections and monoclonal antibodies. Human pathology 1985. link80132-5) 23 Gown AM, Vogel AM. Monoclonal antibodies to human intermediate filament proteins. II. Distribution of filament proteins in normal human tissues. The American journal of pathology 1984. link 24 Trojanowski JQ, Lee VM, Schlaepfer WW. An immunohistochemical study of human central and peripheral nervous system tumors, using monoclonal antibodies against neurofilaments and glial filaments. Human pathology 1984. link80188-4) 25 Naito S, Minoda M, Hirata H. Inverted papilloma of ureter. Urology 1983. link80018-1) 26 Ruiz-Castañeda M. Specific crossreactions between two sera from the same type of malignancy. Archivos de investigacion medica 1981. link 27 Silverstein SV, Carlton CE. Inverted papilloma of ureter. Urology 1981. link90227-2) 28 Shindell S, Goldberg HM. Surveillance systems: what to include and why. Occupational health & safety (Waco, Tex.) 1981. link 29 Tamaddon K. Angiomatous lymphoid choristoma with bone formation: a case report and review of the literature. Pathology, research and practice 1980. link80102-6) 30 Velasco ME, Dahl D, Roessmann U, Gambetti P. Immunohistochemical localization of glial fibrillary acidic protein in human glial neoplasms. Cancer 1980. link45:3<484::aid-cncr2820450312>3.0.co;2-9) 31 Cohen MS, Mcdonald DF, Smith JH. Solitary leiomyoma of the prostate presenting as an encrusted intravesical mass. The Journal of urology 1978. link57309-7) 32 Bolande RP. Neoplasia of early life and its relationships to teratogenesis. Perspectives in pediatric pathology 1976. link 33 Bevilacqua G, Mariani M. Clinico-pathological correlations in a case of primary angiosarcoma of the pericardium. European journal of cardiology 1975. link 34 Bellur SN. Opsoclonus: Its clinical value. Neurology 1975. link 35 Fraley EE, Ecker S, Vincent MM. Spontaneous in vitro neoplastic transformation of adult human prostatic epithelium. Science (New York, N.Y.) 1970. link

Neoplasm